Friday, 16 Nov 2018

You are here

Increasing Deaths and Breaking Bad with Fentanyl

Opioid overdose deaths quadrupled from 1999 to 2015 and accounted for 63% of drug overdose deaths in the United States in 2015. During 2010–2015, heroin overdose deaths quadrupled from 3,036 to 12,989, with heroin and illicitly manufactured fentanyl (IMF) as likely contributors to this trend. (additional citation https://buff.ly/2eHAjpn)

During 2010–2015, unintentional drug overdose deaths in Ohio increased 98%, from 1,544 to 3,050. In Montgomery County (county seat: Dayton), one of the epicenters of the opioid epidemic in the state, unintentional drug overdose deaths increased 40% in 1 year, from 249 in 2015 to 349 in 2016 with an estimated unadjusted mortality rate = 57.7 per 100,000.

Approximately 90% of unintentional overdose deaths examined in 24 Ohio counties that occurred during January–February 2017 involved fentanyl, fentanyl analogs, or both, whereas heroin was identified in the minority (6%) of cases.

Fentanyl is 50-100 fold more potent than morphine, making it much more powerful than heroin or other prescription opioids, according to the U.S. National Institute on Drug Abuse.

What's new is that fentanyl is commonly adulterated and found in combination with other fentanyl analogs. Thus leading to new variations in chemical composition of illicitly manufactured fentanyl (IMF) that make detection more difficult.  Approximately 90% of all decedents tested positive for fentanyl, 48% for acryl fentanyl, 31% for furanyl fentanyl, and 8% for carfentanil. Pharmaceutical opioids were identified in 23% of cases, and heroin in 6%, with higher proportions of heroin-related deaths in Appalachian counties.

These findings highlight the urgent need to make illicitly manufactured fentanyl testing a part of standard toxicology panels for biological specimens. Because multiple naloxone doses are often required to reverse overdoses from illicitly manufactured fentanyl, assuring that sufficient supplies are provided to first responders and distributed through community overdose prevention programs can mitigate the effects of opioid overdoses.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Intensive Patient Education Does Not Improve Low Back Pain Care

JAMA reports on a randomized clinical trial of 202 adults with acute low back pain showing the addition of intensive patient education failed to improve pain outcomes.

This randomized, placebo-controlled clinical trial recruited patients from general practices in Sydney, Australia, between 2013 - 2015. Patients had to have acute low back pain of fewer than 6 weeks’ duration. 

Guidelines for Patellofemoral Pain

New recommendations have been published in the Journal of Athletic Training on the management of patellofemoral pain (PFP).

Complex Pain Syndromes in the Emergency Room

Emergency physician Chris Hahn, MD, doesn't have any trouble conjuring a simple definition of fibromyalgia. "Just think about the most annoying chief complaints you can imagine. That's the diagnostic criteria."

Carpal Tunnel Syndrome - a Leading Cause of Work Related Disability

MMWR reports that workers’ compensation claims for carpal tunnel syndrome (CTS) in California during 2007–2014 were 6.3 per 10,000 full-time equivalent workers, with female workers and workers in industries that manufacture apparel, process food, and perform administrative work being at highest risk for CTS.

Anxiety and Depression are Common in Arthritis Patients

The high prevalence of symptoms of anxiety and depression among adults with arthritis warrants awareness, screening, and subsequent treatment of these conditions. Health care providers can refer patients to mental health professionals and self-management education programs, and encourage physical activity to reduce anxiety and depression symptoms and improve quality of life.