China white epidemic: An eastern united states emergency department experience

Martin, Marcus L.; Hecker, J; Clark, Richard; Frye, Jeffrey; Jehle, Dietrich; Lucid, Emily Jean; Harchelroad, Fred

doi:10.1016/s0196-0644(05)81216-8

Cited by 58 publications

(15 citation statements)

References 18 publications

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“…Chicago reported 342 fatalities, the Detroit metropolitan area reported over 230 fatalities, and Minneapolis reported 23 fatalities, all due to fentanyl intoxication (18–21). Around the same time, an epidemic of 3-methylfentanyl deaths was reported in Europe (22).…”

Section: Introductionmentioning

confidence: 99%

Postmortem Toxicology Findings of Acetyl Fentanyl, Fentanyl, and Morphine in Heroin Fatalities in Tampa, Florida

Pearson

Poklis

et al. 2015

Academic Forensic Pathology

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In the last two years, an epidemic of 40 fatal heroin overdose cases has occurred in the Tampa area of Florida. Of these cases, 14 involved fentanyl and acetyl fentanyl. Victim demographics, case histories, toxicology findings, and causes and manners of death for all 40 deaths are presented. In 26 deaths in which acetyl fentanyl or fentanyl were not involved, free and total peripheral blood morphine concentrations were consistent with fatal heroin intoxications, averaging 0.16 mg/L and 0.35 mg/L, respectively. In the heroin cases with fentanyl present (n=7), the average free morphine concentration was 0.040 mg/L, the average total morphine concentration was 0.080 mg/L, and the average fentanyl concentration was 0.012 mg/L. In the cases with heroin, fentanyl, and acetyl fentanyl (n=3), the average free morphine concentration was 0.010 mg/L, the average total morphine concentration was 0.030 mg/L, the average fentanyl concentration was 0.018 mg/L, and the average acetyl fentanyl concentration was 0.008 mg/L. In the cases involving only acetyl fentanyl (without heroin or fentanyl, n=4), the average acetyl fentanyl concentration was 0.47 mg/L and the average acetyl norfentanyl concentration was 0.053 mg/L. The presented cases, with associated drug concentrations, case histories, demographics, and causes and manners of death may help provide assistance with the interpretation of the postmortem findings. Based on case circumstances, autopsy results, and toxicology results, it is evident that fentanyl and/or acetyl fentanyl, when present, contributed to the cause of death.

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Section: Introductionmentioning

confidence: 99%

Postmortem Toxicology Findings of Acetyl Fentanyl, Fentanyl, and Morphine in Heroin Fatalities in Tampa, Florida

Pearson

Poklis

et al. 2015

Academic Forensic Pathology

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“…The first documented large-scale illicit use of fentanyl (street names: “China White,” “Synthetic Heroin,” “Drop Dead,” “Flatline,” “Lethal Injection,” “Apache,” “China Girl,” “Chinatown,” “Dance Fever,” “Great Bear,” “Poison,” and “Tango & Cash”) was in the USA, mainly in California, between 1979 and 1988 (13–15). Fentanyl exposures reported to the American Association of Poison Control Centers increased from 300 in 2010 to 1,724 in 2011, and since then have remained steadily high (1,632 in 2012, 1,486 in 2013, and 1,418 in 2014) (16).…”

Section: Fentanyl Carfentanil and Non-pharmaceutical Fentanyls (Npf)mentioning

confidence: 99%

An Expanding World of Novel Psychoactive Substances: Opioids

Zawilska

2017

Front. Psychiatry

158

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The abuse of novel psychoactive substances (NPS) has been increasing dramatically worldwide since late 2000s. By the end of 2015, more than 560 NPS had been reported to the European Monitoring Centre for Drugs and Drug Addiction. Although the most popular compounds are synthetic cannabinoids and psychostimulatory derivatives of cathinone (so-called β-keto-amphetamines), novel synthetic opioids have recently emerged on the recreational drug market. They include fentanyl (a potent narcotic analgesic) and its analogs (e.g., acetylfentanyl, acryloylfentanyl, carfentanil, α-methylfentanyl, 3-methylfentanyl, furanylfentanyl, 4-fluorobutyrylfentanyl, 4-methoxybutyrylfentanyl, 4-chloroisobutyrylfentanyl, 4-fluoroisobutyrylfentanyl, tetrahydrofuranylfentanyl, cyclopentylfentanyl, and ocfentanil) and compounds with different chemical structures, such as AH-7921, MT-45, and U-47700. This survey provides an overview of the pharmacological properties, pattern of use, and desired and unwanted effects of the above-listed novel opioids. Special emphasis is given to cases of non-fatal and lethal intoxication involving these compounds.

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“…Overdose deaths due to the use of illicitly manufactured fentanyl by people who use heroin have occurred sporadically for decades (Henderson, 1991; Martin et al, 1991). The first national outbreak of fentanyl-tainted heroin occurred across six jurisdictions in the eastern United States from 2005-2007, and accounted for an excess 1,013 deaths (Centers for Disease & Prevention, 2008).…”

Section: Introductionmentioning

confidence: 99%

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Fairbairn

Coffin

Walley

2017

International Journal of Drug Policy

251

192

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Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone.

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China white epidemic: An eastern united states emergency department experience

Cited by 58 publications

References 18 publications

Postmortem Toxicology Findings of Acetyl Fentanyl, Fentanyl, and Morphine in Heroin Fatalities in Tampa, Florida

Postmortem Toxicology Findings of Acetyl Fentanyl, Fentanyl, and Morphine in Heroin Fatalities in Tampa, Florida

An Expanding World of Novel Psychoactive Substances: Opioids

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

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