Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016

O’Donnell, Julie; Halpin, John F.; Mattson, Christine L.; Goldberger, Bruce A.; Gladden, R. Matthew

doi:10.15585/mmwr.mm6643e1

Cited by 336 publications

(266 citation statements)

References 6 publications

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“…This may be due to the increase in availability and use of illicitly manufactured fentanyl (IMF) and fentanyl analogs in urban areas. In Missouri, evidence suggests that fentanyl analogs began infiltrating the opioid supply in LCM areas in 2015 and has since spread to LFM and MM areas . With the high potency and rapid onset of reaction in the body, it is possible that the increase in overdose ED visits is driven by increases in the introduction of IMF in the drug supply.…”

Section: Discussionmentioning

confidence: 99%

Rural‐Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012‐2016

Coffey

Hunter

Mobley

et al. 2019

The Journal of Rural Health

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Purpose Opioid overdose death rates rose 36% from 2015 to 2016 in Missouri, indicating a worsening of the opioid overdose epidemic. To better understand urban and rural differences in nonfatal opioid overdoses treated in Missouri emergency departments, this paper analyzed hospital billing data from emergency departments due to opioid overdose from 2012 to 2016. Methods Emergency department records meeting the opioid overdose case definition were aggregated into 6 progressively rural groups using the National Center for Health Statistics (NCHS) urban‐rural county classification from 2013. These data were analyzed to determine significant trends amongst and between the geographic groups. Findings Generally, the magnitude of opioid overdose morbidity decreased as levels of rurality increased, using annual percentage change as the metric of change. Over the study period, Missouri's most urban counties had significantly higher rates of opioid overdose and saw larger percentage increases in rates compared to more rural areas. Statewide, all rural‐urban classifications experienced increases in heroin overdose morbidity; however, there was extreme variation in the trajectory of those increases. Heroin overdose rates were much higher in urban areas than rural areas. Conversely, rural and urban areas saw relatively similar patterns for non‐heroin opioid overdoses, though overall magnitude of these increases was more modest across all geographic groups. Conclusions The results from this analysis can help inform prioritization of strategies and resources to implement activities addressing the opioid overdose epidemic. Using a rich hospital discharge database could allow for further analysis of subpopulations to enhance personalization and customization of care.

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Section: Discussionmentioning

confidence: 99%

Rural‐Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012‐2016

Coffey

Hunter

Mobley

et al. 2019

The Journal of Rural Health

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“…Persons who use drugs (PWUD) are often unaware when drugs are “cut”, or mixed with fentanyl (Carroll, Marshall, Rich, & Green, 2017; Macmadu, Carroll, Hadland, Green, & Marshall, 2017; Mars, Ondocsin, & Ciccarone, 2017; Spies et al, 2016; Stogner, 2014). Consequently, use of drugs containing fentanyl have been linked to sharp increases in rates of opioid morbidity and mortality (Centers for Disease Control & Prevention, 2017; Daniulaityte et al, 2017; Katz, 2017; Marshall et al, 2017; O’Donnell, Halpin, Mattson, Goldberger, & Gladden, 2017; Rudd, Aleshire, Zibbell, & Gladden, 2016; Rudd, Seth, David, & Scholl, 2016; Slavova et al, 2017). …”

Section: Introductionmentioning

confidence: 99%

Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl: Adaptations of drug using practices among people who use drugs (PWUD) in New York City

McKnight

Jarlais

2018

International Journal of Drug Policy

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Illicitly manufactured fentanyl (IMF), a category of synthetic opioids 50-100 times more potent than morphine, is increasingly being added to heroin and other drugs in the United States (US). Persons who use drugs (PWUD) are frequently unaware of the presence of fentanyl in drugs. Use of heroin and other drugs containing fentanyl has been linked to sharp increases in opioid mortality. In New York City (NYC), opioid-related mortality increased from 8.2 per 100,000 residents in 2010 to 19.9 per 100,000 residents in 2016; and, in 2016, fentanyl accounted for 44% of NYC overdose deaths. Little is known about how PWUD are adapting to the increase in fentanyl and overdose mortality. This study explores PWUDs' adaptations to drug using practices due to fentanyl. In-depth qualitative interviews were conducted with 55 PWUD at three NYC syringe services programs (SSP) about perceptions of fentanyl, overdose experiences and adaptations of drug using practices. PWUD utilized test shots, a consistent drug dealer, fentanyl test strips, naloxone, getting high with or near others and reducing drug use to protect from overdose. Consistent application of these methods was often negated by structural level factors such as stigma, poverty and homelessness. To address these, multi-level overdose prevention approaches should be implemented in order to reduce the continuing increase in opioid mortality.

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“…Fentanyl analogs are reported to be implicated in numerous opioid overdose cases both in Europe (EMCDDA 2017a, b, c) and North America (O’Donnell et al 2017). …”

Section: Introductionmentioning

confidence: 99%

Correlations between metabolism and structural elements of the alicyclic fentanyl analogs cyclopropyl fentanyl, cyclobutyl fentanyl, cyclopentyl fentanyl, cyclohexyl fentanyl and 2,2,3,3-tetramethylcyclopropyl fentanyl studied by human hepatocytes and LC-QTOF-MS

et al. 2018

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Recently, a number of fentanyl analogs have been implicated in overdose deaths in Europe and in the US. So far, little is known of the molecular behavior of the structurally related subgroup; the alicyclic fentanyls. In this study, reference standards of cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and 2,2,3,3-tetramethylcyclopropyl fentanyl (TMCPF) at a final concentration of 5 µM were incubated with cryopreserved human hepatocytes (1 × 106 cells/mL) for 0, 1, 3 and 5 h. The metabolites formed were identified by liquid chromatography–quadrupole time-of-flight mass spectrometry analysis. The most abundant biotransformation found was N-dealkylation (formation of normetabolites) and oxidation of the alicyclic rings. As ring size increased, the significance of N-dealkylation decreased in favor of alicyclic ring oxidation. An example of this was cyclopropyl fentanyl, with a three-carbon ring, whose normetabolite covered 82% of the total metabolic peak area and no oxidation of the alicyclic ring was observed. In contrast, TMCPF, with a seven-carbon ring structure, rendered as much as 85% of its metabolites oxidized on the alicyclic ring. Other biotransformations found included oxidation of the piperidine ethyl moiety and/or the phenethyl substructure, glucuronidation as well as amide hydrolysis to form metabolites identical to despropionyl fentanyl. Taken together, this study provides a base for understanding the metabolism of a number of structurally related fentanyl analogs formed upon intake.Electronic supplementary materialThe online version of this article (10.1007/s00204-018-2330-9) contains supplementary material, which is available to authorized users.

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Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016

Cited by 336 publications

References 6 publications

Rural‐Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012‐2016

Rural‐Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012‐2016

Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl: Adaptations of drug using practices among people who use drugs (PWUD) in New York City

Correlations between metabolism and structural elements of the alicyclic fentanyl analogs cyclopropyl fentanyl, cyclobutyl fentanyl, cyclopentyl fentanyl, cyclohexyl fentanyl and 2,2,3,3-tetramethylcyclopropyl fentanyl studied by human hepatocytes and LC-QTOF-MS

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