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Overdose Deaths Related to Fentanyl and Its Analogs - Ohio, January-February 2017.

Abstract Ohio is experiencing unprecedented loss of life caused by unintentional drug overdoses (1), with illicitly manufactured fentanyl (IMF) emerging as a significant threat to public health (2,3). IMF is structurally similar to pharmaceutical fentanyl, but is produced in clandestine laboratories and includes fentanyl analogs that display wide variability in potency (2); variations in chemical composition of these drugs make detection more difficult. 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 (estimated unadjusted mortality rate = 57.7 per 100,000) (4). IMFs have not been part of routine toxicology testing at the coroner's offices and other types of medical and criminal justice settings across the country (2,3). Thus, data on IMF test results in the current outbreak have been limited. The Wright State University and the Montgomery County Coroner's Office/Miami Valley Regional Crime Laboratory (MCCO/MVRCL) collaborated on a National Institutes of Health study of fentanyl analogs and metabolites and other drugs identified in 281 unintentional overdose fatalities in 24 Ohio counties during January-February 2017. 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. The majority of decedents tested positive for more than one type of fentanyl. Evidence suggests the growing role of IMFs, and the declining presence of heroin and pharmaceutical opioids in unintentional overdose fatalities, compared with 2014-2016 data from Ohio and other states (3-5). There is a need to include testing for IMFs as part of standard toxicology panels for biological specimens used in the medical, substance abuse treatment, and criminal justice settings.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title mmwr. morbidity and mortality weekly report
Publication Year Start




PMID- 28859050
OWN - NLM
STAT- MEDLINE
DA  - 20170831
DCOM- 20170905
LR  - 20170906
IS  - 1545-861X (Electronic)
IS  - 0149-2195 (Linking)
VI  - 66
IP  - 34
DP  - 2017 Sep 01
TI  - Overdose Deaths Related to Fentanyl and Its Analogs - Ohio, January-February
      2017.
PG  - 904-908
LID - 10.15585/mmwr.mm6634a3 [doi]
AB  - Ohio is experiencing unprecedented loss of life caused by unintentional drug
      overdoses (1), with illicitly manufactured fentanyl (IMF) emerging as a
      significant threat to public health (2,3). IMF is structurally similar to
      pharmaceutical fentanyl, but is produced in clandestine laboratories and includes
      fentanyl analogs that display wide variability in potency (2); variations in
      chemical composition of these drugs make detection more difficult. 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 (estimated unadjusted mortality
      rate = 57.7 per 100,000) (4). IMFs have not been part of routine toxicology
      testing at the coroner's offices and other types of medical and criminal justice 
      settings across the country (2,3). Thus, data on IMF test results in the current 
      outbreak have been limited. The Wright State University and the Montgomery County
      Coroner's Office/Miami Valley Regional Crime Laboratory (MCCO/MVRCL) collaborated
      on a National Institutes of Health study of fentanyl analogs and metabolites and 
      other drugs identified in 281 unintentional overdose fatalities in 24 Ohio
      counties during January-February 2017. 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. The majority of decedents tested positive for more than one type of
      fentanyl. Evidence suggests the growing role of IMFs, and the declining presence 
      of heroin and pharmaceutical opioids in unintentional overdose fatalities,
      compared with 2014-2016 data from Ohio and other states (3-5). There is a need to
      include testing for IMFs as part of standard toxicology panels for biological
      specimens used in the medical, substance abuse treatment, and criminal justice
      settings.
FAU - Daniulaityte, Raminta
AU  - Daniulaityte R
FAU - Juhascik, Matthew P
AU  - Juhascik MP
FAU - Strayer, Kraig E
AU  - Strayer KE
FAU - Sizemore, Ioana E
AU  - Sizemore IE
FAU - Harshbarger, Kent E
AU  - Harshbarger KE
FAU - Antonides, Heather M
AU  - Antonides HM
FAU - Carlson, Robert R
AU  - Carlson RR
LA  - eng
PT  - Journal Article
DEP - 20170901
PL  - United States
TA  - MMWR Morb Mortal Wkly Rep
JT  - MMWR. Morbidity and mortality weekly report
JID - 7802429
RN  - 0 (Street Drugs)
RN  - UF599785JZ (Fentanyl)
SB  - IM
MH  - Adult
MH  - Drug Overdose/*mortality
MH  - Female
MH  - Fentanyl/*analogs & derivatives/*poisoning
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ohio/epidemiology
MH  - Street Drugs/*poisoning
MH  - Young Adult
EDAT- 2017/09/01 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/09/01 06:00
AID - 10.15585/mmwr.mm6634a3 [doi]
PST - epublish
SO  - MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):904-908. doi:
      10.15585/mmwr.mm6634a3.