Carfentanil and the rise and fall of overdose deaths in the United States

Abstract

Background and Aims It is widely believed that the 2018 decline in overdose deaths in the United States was attributable to a range of public health interventions, however, this decline also coincided with the regulation and decline in use of potent fentanyl analogs, especially carfentanil. The aim of this study was to investigate the association between overdose deaths and carfentanil availability in the United States. Design Secondary analysis of drug overdose deaths from the Center for Disease Control and Prevention (CDC) and carfentanil exhibit data from drug seizures submitted to drug crime labs and published by the Drug Enforcement Administration (DEA). Trends in overdose deaths were compared in states with high carfentanil exhibits with states with low or no carfentanil exhibits. Setting United States. Participants A total of 1 035 923 drug overdose death records in the United States from 1979 through 2019 were studied. Measurements The outcomes studied were number of overdose deaths and mortality rates by state. Findings Drug overdose deaths have been closely tracked along an exponential curve. The years 2016 and 2017 witnessed a hyper‐exponential surge with increases in overdose deaths of 11 228 (+21.4%) and 6605 (+10.4%), respectively. Subsequently in 2018, drug overdose deaths declined by −2870 (−4.1%). This rise and then fall coincided with a surge and then decline in carfentanil drug seizure exhibits during these same years: 0 (2015), 1292 (2016), 5857 (2017) and 804 (2018). The majority of carfentanil exhibits were localized to a few states. The 2018 decline in overdose deaths in the top five states with the greatest spike in carfentanil exhibits in 2017 (Ohio, Florida, Pennsylvania, Kentucky and Michigan) was 2848, which accounted for nearly all of the total US decline. Conclusions The 2016–2017 acceleration and then 2018 decline in drug overdose deaths in the United States was associated with the sudden rise and then fall of carfentanil availability. Given the regional variation, carfentanil's decreased availability may have contributed to the reduction in overdose deaths in 2018.

Has the United States Reached a Plateau in Overdoses Caused by Synthetic Opioids After the Onset of the COVID-19 Pandemic? Examination of Centers for Disease Control and Prevention Data to November 2021

“…It cannot be excluded that the plateaus observed at the end of the study period in 29 authorities are temporary, and that further increases may occur in the future ( 17 , 31 , 34 , 50 ). Only one state examined here, New Hampshire, showed a decrease in mortality due to synthetic opioids, compared to baseline.…”

Exponential growth of drug overdose poisoning and opportunities for intervention

“…We see common and distinct threads in these commentaries. In their summaries of the recent experience of Estonia and Sweden, Abel-Ollo [1] and Fugelstad [2], respectively, suggest an escalation in fatal poisonings from synthetic fentanyl can be curtailed if there is a concerted effort to help victims while law enforcement knocks out major distributors. For Bergeron and Colson [3] and Clausen [4], the policies in France and Norway share features and the combined effects of needle and syringe exchange services, low threshold opioid prescribing services and take-home naloxone schemes seem to have delivered success.…”

“…One recent example of a transient period of hyper‐exponential growth followed by a temporary period of slowing with return to basic trajectory was the 2016‐2017‐2018 rise and fall in overdose (OD) deaths, due almost entirely to a transient surge in the availability of carfentanil. What was deemed as a political success in 2018 was in fact a return to the long‐term exponential trend line [2].…”

Policy Responses to the Addiction Crisis

“…The Biden administration can also make fentanyl a top priority in dealings with China. Controls imposed for synthetic opioids produced within its borders have evidence of translating into reduced deaths in the US (Jalal and Burke 2020).…”