An opioid 100 times deadlier than fentanyl killed her. She won’t be the last.

On the morning of her death, Eleanor Neal walked her beloved dog Ruby around her suburban D.C. neighborhood before driving to a stretch of abandoned rowhomes in Southwest Baltimore.

Later that day, an anonymous 911 call led first responders to one of the buildings, where they found the body of the 26-year-old, who had worked with autistic children and was a voracious reader.

Her body had been stripped of all valuables, even her shoes and piercing jewelry, according to her father, Daniel Neal. A toxicology report showed she had taken illegal drugs tainted with an ultra-deadly chemical, so powerful that mere milligrams can knock out an elephant.

The substance is called carfentanil. It first alarmed health and law enforcement officials a decade ago when it was linked to a wave of fatalities across the country before it suddenly faded.

But in today’s wildly unpredictable drug supply, carfentanil appears to be making a deadly resurgence.

In 2025, Eleanor was one of 79 people who died in Maryland after carfentanil exposure. That’s more than double the number of related deaths from the previous seven years combined, according to state data.

Carfentanil is an extraordinarily potent synthetic opioid used to immobilize large animals. It is similar in chemical composition to fentanyl, which is behind two out of every three fatal overdoses in Maryland. But it’s 100 times stronger, making the likelihood of death much greater.

Last year, more than 1,400 people died from overdoses in the state, down 50% from a peak in 2021. Officials heralded the promising trend, while some experts attributed an overall nationwide drop to drug traffickers having trouble obtaining chemicals needed to make fentanyl.

But dealers have introduced other powerful and cheap-to-manufacture substances into their drug supplies, possibly to compensate, according to some experts.

It’s not clear how carfentanil entered the drug supply, or why it had all but disappeared for years. But now scientists at the Centers for Disease Control and Prevention are warning that it may threaten the recent progress in combating overdoses.

The Maryland Department of Health drew attention to the issue in August, reporting that carfentanil had been detected in drug samples and deaths in several counties.

“Using very small doses of the substance can lead to an overdose,” officials cautioned. By the end of 2024, the substance had been detected in overdose deaths in 37 states, according to the CDC.

As the reemerging drug threat looms, a question consumes Neal, the grieving father: How can we prevent others from dying?

This question is at the heart of a debate between proponents of law enforcement, who see the drug trade as something to be punished, and supporters of an approach called harm reduction that centers the needs of people who use drugs.

Eleanor would not have known she was using such a deadly substance, according to her father. In the past, she had sought benzodiazepines — a type of prescription sedative — to self-medicate depression, anxiety and post-traumatic stress disorder, he said.

Through her teens, she spent time in residential treatment programs to address these mental health challenges. Neal believes those issues stemmed from an orange-sized brain tumor discovered when she was a toddler.

But in recent years, Eleanor’s life seemed to be stabilizing. She had a job she loved, a close group of friends who supported each other through their addiction recovery journeys, and a book-filled home of her own. She recently bought a dress for her brother’s upcoming wedding and was planning a trip to Ireland.

No one knows what led to her deadly relapse. Experts say relapses are a common part of recovery, but the carfentanil Eleanor took last November meant she did not get another chance.

After Eleanor died, someone stole her car and used it for a week, Neal said. With his help, police found it parked blocks away. Neal believes items left behind plus phone records and credit card purchases could lead authorities to the people who sold Eleanor carfentanil-laced drugs.

It doesn’t appear, however, that police intend to investigate further. With no signs of trauma or evidence to suggest foul play, the case has been closed, according to Baltimore Police Department spokesperson Lindsey Eldridge.

Neal said he has continued to urge authorities to investigate Eleanor’s death as a homicide. In his eyes, Eleanor’s death should not be considered an overdose, but a poisoning. And those who he believes poisoned her should be stopped.

“Is this about vengeance?” Neal said. “No. It’s about the question of what is just.”

In many parts of the country, people have gone to prison for their role in overdose deaths, news reports show. A small but growing number of cases have involved carfentanil.

In recent years, some Maryland lawmakers have unsuccessfully tried to pass a bill to extend prison sentences for people who deal opioids that kill others.

Testifying in support of the bill in 2025, the Maryland attorney general’s criminal division deputy chief, Jared Albert, wrote that it would “bring greater accountability to those who sell fentanyl within our communities” and provide “a sorely needed new avenue to seek justice for fatal overdose victims.”

North Carolina State University anthropology professor Jennifer Carroll began researching similar proposals after the 2017 overdose death of a woman in North Carolina resulted in a long prison sentence for a dealer and a law that made it easier to prosecute drug-related deaths as homicides.

While law enforcement officials tout arrests and drug seizures, there is little evidence that crackdowns on drug dealers reduce fatal overdoses, according to Carroll. In fact, some research has shown that it can make things worse.

Seizures can lead people to buy drugs from new dealers with unfamiliar supplies, leading to more overdoses, studies have suggested. Additionally, people may be less likely to call 911 for help if they’re afraid of getting in trouble, Carroll said.

While she does not have an answer to the thorny question of what feels like “justice,” Carroll said it’s clear that “if we’re trying to keep people from dying, drug-induced homicide charges at best do nothing, and at worst increases the likelihood another family will experience the same loss.”

One way to save lives is to expand access to naloxone, an overdose-reversal drug that works against opioids like carfentanil.

Another strategy is offering drug-checking services, Carroll said. People who use drugs, and even dealers, often have no idea what is in the drug supply. Knowing the chemicals in a batch of drugs can help people make better-informed decisions.

“That’s exactly the type of service you need to be scaling up as rapidly as possible if you have carfentanil in your supply,” she said.

Two years ago, a team from the Johns Hopkins Bloomberg School of Public Health began driving a van to street corners in Baltimore, armed with drug testing strips and a machine that uses infrared light to identify chemical compounds.

The program, called Check It, is the only one in Maryland that can identify the contents of drug samples in minutes. Its technicians only need a tiny amount of a substance — equivalent to half a grain of rice — which can be returned to the client.

“A lot of people when they first encounter Check It, they’re like, ‘You’re the cops, right? What is this?’” said program director Danielle Friedman Nestadt, explaining that people aren’t used to getting information about drugs outside of law enforcement or treatment.

On a recent Wednesday, whiteboards posted outside the van listed findings. A sample of “MDMA” actually contained methamphetamine, caffeine and a neurotoxic product of burning crack cocaine. Samples of “dope” had any of 10 different substances, including fentanyl and xylazine, an animal sedative which can cause gaping flesh wounds.

Another veterinarian medication that has been detected by Check It is medetomidine, which can lead to dangerous withdrawals.

There are limitations. The toaster oven-sized machine on the van is not powerful enough to reliably detect carfentanil, which typically shows up in tiny quantities and resembles fentanyl, Nestadt said. But technicians also collect swabs to mail to the National Institute of Standards and Technology’s laboratory in Gaithersburg for further testing.

For the first time last year, a drug-checking program that works with the laboratory identified carfentanil in five out of more than 1,800 samples, according to state health department spokesperson Amanda Hils. Recently, the state began publishing drug-checking results online.

In February, Baltimore officials announced Check It will receive $250,000 from the city’s opioid restitution fund. The grant will help the van respond to mass overdoses like the ones that hospitalized dozens in Baltimore’s Penn North neighborhood last year, Nestadt said.

One of the program’s weekly stops is in Southwest Baltimore, only one block from the rowhome where Eleanor took her final breath.

Her father said beyond seeking justice for Eleanor, he also wants people to be aware of the dangers associated with carfentanil.

“No one is saying there is one magic thing to do,” he said, adding, “I think it begins with education.”