The use of synthetic opioid analogues is emerging as a means to concentrate the effect, and hence profits, of heroin and other oft-abused drugs. The word “opium” is derived from the ancient Greek word opion, which means poppy juice, so this is clearly not a new substance. The new twist to the problem is the synthesis of extraordinarily concentrated—and thus more potent—analogues. Although drug trafficking is a worldwide issue, some communities seem to have been particularly hard hit, while others have so far been relatively spared. As this issue progresses, there is much concern about the risk to first responders. The penetration of synthetic fentanyl analogues into a community is a rapidly evolving process, and there is no central reporting of injuries to officers to contribute to a timely analysis of what measures may work to improve officer survival. Many recommendations are based on fentanyl, which is more potent than morphine, but fentanyl is not as potent as carfentanyl, which is a veterinary medication used to tranquilize large animals that is making its way into the drug markets. The following discussion is a distillation of some of the most recent suggestions by various subject matter experts regarding how police should respond to calls for service that may involve carfentanyl and similar analogues.