Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016

Abstract

Drug overdose deaths are at unprecedented levels in the United States. 1 Prescription opioids have been the most common drug involved in overdose deaths, but heroin and synthetic opioids (primarily illicit fentanyl) are increasingly implicated in overdoses. 2 In addition, synthetic opioids are increasingly found in illicit drug supplies of heroin, cocaine, methamphetamine, and counterfeit pills. 3 To date, the involvement of synthetic opioids in overdose deaths involving other drugs is not well characterized, limiting the ability to implement effective clinical and public health strategies. Using 2010-2016 mortality data, we describe recent trends for synthetic opioid involvement in drug overdose deaths.

Epidemiology of the U.S. opioid crisis: the importance of the vector

“…Among overdose deaths, the majority of opioid‐involved overdose deaths also involved multiple drugs (or alcohol). In 2016, approximately 80% of synthetic opioid–related overdose deaths involved at least one other drug or alcohol, with heroin, cocaine, prescription opioids, and benzodiazepines being the most common co‐involved substances . Such combinations, especially with respiratory depressants, such as alcohol and benzodiazepines, increase the risk of overdose …”

“…Within the rubric of illicit opioid use, a further distinction can be drawn between the resurgent use of heroin and the problem of both deliberate and unintentional use of even more potent synthetic opioid drugs (namely, illicitly made fentanyl and its analogs). A rapid rise in deaths involving these synthetic opioids, beginning in 2013, marked a third wave of the opioid crisis . From 2010 to 2017, deaths from fentanyl and other synthetic opioids increased nearly 10‐fold, from around 3007 (14.3% of opioid‐related deaths) to 28,466 (59.8%) .…”

“…A rapid rise in deaths involving these synthetic opioids, beginning in 2013, marked a third wave of the opioid crisis . From 2010 to 2017, deaths from fentanyl and other synthetic opioids increased nearly 10‐fold, from around 3007 (14.3% of opioid‐related deaths) to 28,466 (59.8%) . Synthetic opioids are now almost twice as commonly involved in overdose deaths as prescription opioids or heroin…”

Surface‐enhanced Raman spectroscopy, Raman, and density functional theoretical analyses of fentanyl and six analogs

“…Over this time, fentanyl abuse has been escalating. In 2016, fentanyl‐related opioid abuse resulted in 19,413 overdose deaths, which was 45.9% of all reported drug overdose death . Since February 2018, the Drug Enforcement Administration has listed fentanyl as a Schedule II drug and fentanyl‐related substances as Schedule I drugs…”

Opioid Therapy in Acute and Chronic Pain

“…Coprescription of naloxone should be considered for patients who are on high doses of opioids, have children in the environment or home, are on formulations that increase the risk of overdose (eg, fentanyl patch, long‐acting formulations), have experienced an overdose, or have a diagnosis of substance use disorder but need to take opioids. Because of the recent increase of opioid overdose deaths due to synthetic opioids such as fentanyl and carfentanyl, the recommendation has been made to administer a standard initial intramuscular dose of naloxone 2 mg (rather than 0.4 mg) or 4 mg by intranasal administration . There are no safety concerns with the higher naloxone dose …”