In the Journals

CDC: Increases in synthetic opioid overdoses due to fentanyl

Recent findings in MMWR indicated significant increases in synthetic opioid-related overdoses, which were primarily attributed to fentanyl-related overdose deaths, in multiple states in several regions of the U.S.

“In March and October 2015, the Drug Enforcement Administration (DEA) and CDC, respectively, issued nationwide alerts identifying illicitly manufactured fentanyl (IMF) as a threat to public health and safety. IMF is unlawfully produced fentanyl, obtained through illicit drug markets, includes fentanyl analogs, and is commonly mixed with or sold as heroin. Starting in 2013, the production and distribution of IMF increased to unprecedented levels, fueled by increases in the global supply, processing, and distribution of fentanyl and fentanyl-precursor chemicals by criminal organizations,” R. Matthew Gladden, PhD, of CDC’s National Center for Injury Prevention and Control, and colleagues wrote.

Researchers analyzed fentanyl submission data from the DEA National Forensic Laboratory Information System, synthetic opioid deaths, national and state fentanyl prescription data and medical examiner/coroner reports or death certificate data from states with a high burden of synthetic opioid deaths for 2013 to 2014.

From 2013 to 2014, fentanyl submissions increased by 426% and synthetic opioid deaths increased by 79%. Conversely, fentanyl prescription rates remained relatively stable, according to researchers.

Changes in fentanyl submissions and synthetic opioid death rates were highly correlated among the 27 states analyzed; however, change in state-level synthetic opioid deaths were not correlated with changes in fentanyl prescribing.

Eight states were identified as high burden for synthetic opioid deaths: Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.

In these states, the crude synthetic opioid death rate increased from 1.3 per 100,000 in 2013 to 3.6 per 100,000 in 2014, a 174% increase.

Fentanyl submission rates increased by 1,000%, from 0.5 to 5.5 per 100,000.

In 2014, the highest rates of synthetic opioid deaths were among males (5.1 per 100,000), non-Hispanic whites (4.6 per 100,000), and individuals aged 25 to 34 years (8.3 per 100,000), 35 to 44 years (7.4 per 100,000) and 45 to 54 years (5.7 per 100,000).

A separate analysis of fentanyl-related overdose deaths in Florida and Ohio indicated that fentanyl submissions increased by 494% in Florida and 1,043% in Ohio from 2013 to 2014.

Fentanyl deaths increased by 115% in Florida and 526% in Ohio.

From 2013 to 2014, the highest fentanyl death rates in Florida occurred among individuals aged 26 to 34 years (3.2 per 100,000), aged 35 to 50 years (2.9 per 100,000), males (2.5 per 100,000) and whites (2.1 per 100,000).

The highest fentanyl death rates in Ohio occurred among individuals aged 25 to 34 years (10.5 per 100,000), aged 35 to 44 years (9.2 per 100,000), males (5.6 per 100,000), whites (4.2 per 100,000), individuals who were never married/single (8.4 per 100,000) and had less than a high school diploma (9.9 per 100,000).

“The Secretary of Health and Human Services has launched an initiative to reduce opioid misuse, abuse, and overdose by expanding medication-assisted treatment, increasing the availability and use of naloxone, and promoting safer opioid prescribing,” Gladden and colleagues wrote. “Efforts should focus on 1) improving timeliness of opioid surveillance to facilitate faster identification and response to spikes in fentanyl overdoses; 2) expanding testing for fentanyl and fentanyl analogs by physicians, treatment programs, and medical examiners/coroners in high-burden states; 3) expanding evidence-based harm reduction and expanding naloxone access, with a focus on persons using heroin; 4) implementing programs that increase linkage and access to medication-assisted treatment, with a focus on persons using heroin; 5) increasing collaboration between public health and public safety; and 6) planning rapid response in high-burden states and states beginning to experience increases in fentanyl submissions or deaths.” – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.

Recent findings in MMWR indicated significant increases in synthetic opioid-related overdoses, which were primarily attributed to fentanyl-related overdose deaths, in multiple states in several regions of the U.S.

“In March and October 2015, the Drug Enforcement Administration (DEA) and CDC, respectively, issued nationwide alerts identifying illicitly manufactured fentanyl (IMF) as a threat to public health and safety. IMF is unlawfully produced fentanyl, obtained through illicit drug markets, includes fentanyl analogs, and is commonly mixed with or sold as heroin. Starting in 2013, the production and distribution of IMF increased to unprecedented levels, fueled by increases in the global supply, processing, and distribution of fentanyl and fentanyl-precursor chemicals by criminal organizations,” R. Matthew Gladden, PhD, of CDC’s National Center for Injury Prevention and Control, and colleagues wrote.

Researchers analyzed fentanyl submission data from the DEA National Forensic Laboratory Information System, synthetic opioid deaths, national and state fentanyl prescription data and medical examiner/coroner reports or death certificate data from states with a high burden of synthetic opioid deaths for 2013 to 2014.

From 2013 to 2014, fentanyl submissions increased by 426% and synthetic opioid deaths increased by 79%. Conversely, fentanyl prescription rates remained relatively stable, according to researchers.

Changes in fentanyl submissions and synthetic opioid death rates were highly correlated among the 27 states analyzed; however, change in state-level synthetic opioid deaths were not correlated with changes in fentanyl prescribing.

Eight states were identified as high burden for synthetic opioid deaths: Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.

In these states, the crude synthetic opioid death rate increased from 1.3 per 100,000 in 2013 to 3.6 per 100,000 in 2014, a 174% increase.

Fentanyl submission rates increased by 1,000%, from 0.5 to 5.5 per 100,000.

In 2014, the highest rates of synthetic opioid deaths were among males (5.1 per 100,000), non-Hispanic whites (4.6 per 100,000), and individuals aged 25 to 34 years (8.3 per 100,000), 35 to 44 years (7.4 per 100,000) and 45 to 54 years (5.7 per 100,000).

A separate analysis of fentanyl-related overdose deaths in Florida and Ohio indicated that fentanyl submissions increased by 494% in Florida and 1,043% in Ohio from 2013 to 2014.

Fentanyl deaths increased by 115% in Florida and 526% in Ohio.

From 2013 to 2014, the highest fentanyl death rates in Florida occurred among individuals aged 26 to 34 years (3.2 per 100,000), aged 35 to 50 years (2.9 per 100,000), males (2.5 per 100,000) and whites (2.1 per 100,000).

The highest fentanyl death rates in Ohio occurred among individuals aged 25 to 34 years (10.5 per 100,000), aged 35 to 44 years (9.2 per 100,000), males (5.6 per 100,000), whites (4.2 per 100,000), individuals who were never married/single (8.4 per 100,000) and had less than a high school diploma (9.9 per 100,000).

“The Secretary of Health and Human Services has launched an initiative to reduce opioid misuse, abuse, and overdose by expanding medication-assisted treatment, increasing the availability and use of naloxone, and promoting safer opioid prescribing,” Gladden and colleagues wrote. “Efforts should focus on 1) improving timeliness of opioid surveillance to facilitate faster identification and response to spikes in fentanyl overdoses; 2) expanding testing for fentanyl and fentanyl analogs by physicians, treatment programs, and medical examiners/coroners in high-burden states; 3) expanding evidence-based harm reduction and expanding naloxone access, with a focus on persons using heroin; 4) implementing programs that increase linkage and access to medication-assisted treatment, with a focus on persons using heroin; 5) increasing collaboration between public health and public safety; and 6) planning rapid response in high-burden states and states beginning to experience increases in fentanyl submissions or deaths.” – by Amanda Oldt

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.