A deadly trend in fentanyl fatalities (England, 1998–2017)

Abstract

Aim To identify trends in drug‐related deaths associated with fentanyl and its derivatives, including novel variants, in England, 1998–2017. Methods Case reports from the National Programme on Substance Abuse Deaths (NPSAD) where a pharmaceutical fentanyl or non‐pharmaceutical fentanyl derivative (NPFD) was found at post‐mortem and/or implicated in the death were extracted for analysis. Results NPSAD has received case reports detailing 298 deaths in England from 1998–2017 where a fentanyl was found at post‐mortem and/or implicated in the death. Hospital administered fentanyl is “very safe”, whereas pharmaceutical fentanyls in the community, procured either legitimately via prescription or illegitimately, carry high risk of unintentional death. Deaths involving NPFDs, which possess extreme potencies in comparison to morphine, have drastically risen over the past three years, and correlate with an increasing number of available compounds. Males, and those with existing opioid abuse disorders, are particularly susceptible to death related to NPFD intake. Conclusions The increasing availability of both pharmaceutical fentanyls and NPFDs represents a serious risk to public health. Unintentional misuse of these compounds in England is contributing to the exponential increase in fentanyl‐associated deaths that is being observed at the global scale.

Drug‐related deaths associated with vaping product use in the United Kingdom

“…The King's College London (KCL) Biomedical and Health Sciences, Dentistry, Medicine and Natural and Mathematical Sciences Research Ethics SubCommittee (BDM RESC) confirmed in November 2020 that NPSAD does not require REC review, as all subjects are deceased [12].…”

“…police, emergency services), general practitioner (GP), psychiatric and hospital records, as well as post-mortem and toxicology results. The King's College London (KCL) Biomedical and Health Sciences, Dentistry, Medicine and Natural and Mathematical Sciences Research Ethics SubCommittee (BDM RESC) confirmed in November 2020 that NPSAD does not require REC review, as all subjects are deceased [12].…”

Commentary: New Complications Make Treatment of “Opioid” Overdose Challenging

“…There have even been platelet effects reported for fentanyl [13]. Polysubstance use is a common finding with fentanoids: alcohol, benzodiazepines, and illicit substances [21]. Many individuals who overdose on these combinations often are unaware that a fentanoid was involved [8] [21].…”

“…Polysubstance use is a common finding with fentanoids: alcohol, benzodiazepines, and illicit substances [21]. Many individuals who overdose on these combinations often are unaware that a fentanoid was involved [8] [21]. Due to their high lipid solubility, fentanoids have different binding profiles at opioid receptors that modifies the "agonist:antagonist" ratio, impeding equilibrium competition, which may reduce the ability of naloxone to displace them [22].…”

Case report on postmortem fentanyl measurement after overdose with more than 67 fentanyl patches

“…Although the awareness of these problems has increased in the last few years, this did not prevent further deaths due to fentanyl. Recent studies have even reported an increasing number of fentanyl intoxications and deaths by fentanyl overdoses, both intentional and unintentional [5][6][7].…”