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Objectives. To identify opioids associated with a spike in opioid-related mortality in Wayne County, Michigan, from July 2016 through February 2017. Methods. We reviewed records from the Wayne County Medical Examiner’s Office of 645 people who died because of accidental nonmedically prescribed opioid overdoses from July 2015 through July 2017. We analyzed basic demographics, locations of death, and all opioid toxicology results. Decedents who died in hospitals were excluded. Results. Of the 645 people who died because of nonmedically prescribed opioid overdoses, 65% were male and 63% were White, with an average age of 43 years. Carfentanil was detected in 129 (20%) cases. During the 8-month mortality spike, carfentanil was detected in 114 of 419 cases (average = 27.2%; range = 6.4%–45.2%). Substances most frequently detected with carfentanil included morphine (57%), 6-monoacetylmorphine (38%), fentanyl (43%), norfentanyl (33%), tetrahydrocannabinol (34%), and cocaine (29%). Conclusions. The Wayne County spike in mortality temporally corresponded with the detection of carfentanil and a proportional increase in opioid overdose deaths with detectable carfentanil. Public Health Implications. The abrupt decrease in carfentanil-detected mortality coincided with an announcement indicating an impending ban on fentanyl analogs from China, which suggests that source control is an effective countermeasure.

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Study Objectives: Patients with chronic hypertension (HTN), particularly those who reside in under resourced settings, are highly susceptible to poor blood pressure (BP) control. Medication non-adherence is an important contributor to this but little progress has been made on improving therapeutic compliance. The objective of this study was to determine how barriers to medication adherence among patients who present to the emergency department (ED) with a medical history of HTN may contribute to poor BP control.Methods: Using data collected from an ongoing, prospective HTN registry, 295 participants with a medical history of HTN visiting 1 of our 3 urban EDs completed the Adherence to Refills and Medications scale (ARMS)-14 survey which consists of 14 Likert scale (1¼ none of time: 2¼ some of the time; 3¼ most of the time; 4¼ all of the time) questions in 2 domains: adherence to taking medication correctly (Factor I) and to refilling medication prescribed (Factor II). Any ARMS-14 response of "1" is considered an indicator of non-adherence. Total ARMS-14 score was compared to BP using linear regression and Wilcoxon Rank sums using SAS version 9.4 and Tableau version 10.4 were derived.Results: The average systolic BP was 150.6 mmHg. The average for those with controlled HTN (<130 mmHg) was 117.4 mmHg (n¼69) compared to 160.7 mmHg (n¼226) in those with uncontrolled HTN (>130 mmHg). The mean weighted ARMS-14 score of the participants was 1.61. There was a positive correlation (R-squared¼0.02; p < 0.05) on linear regression between overall ARMS-14 score and systolic BP. The mean weighted Factor I scores among patients with controlled HTN were also lower than those with uncontrolled HTN (11.71 versus 12.58, p ¼ 0.01); however, the mean weighted Factor II scores were not (6.94 and 7.11, respectively, p¼0.55). Four individual survey questions were statistically different between groups ("How often do you forget to take your medicine?"; "How often do you decide not to take your medicine?"; "How often do you miss taking your medicine when you feel sick?"; and "How often do you take someone else's medicine?").Conclusions: Poor adherence by ARMS-14 is associated with uncontrolled HTN. Non-adherence to taking medication correctly rather than refiling prescriptions may be a particularly important barrier among ED patients with chronic HTN.

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