Emergence of fentanyl‐related deaths in Travis County, Texas and surrounding areas: A retrospective review of postmortem fentanyl‐related drug toxicities from 2020 to 2022

Abstract

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl‐related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl‐related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest‐growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl‐related deaths over this 3‐year period (n = 517). Fentanyl‐related fatalities primarily occurred in males in their mid‐30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co‐positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl‐related deaths. Illicit oxycodone (44%, n = 67) and illicit “Xanax” (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.

Introduction to the JFS Special Section on Fentanyl and its Analogs in Forensic Science

“…The final articles are on forensic pathology and forensic toxicology [13][14][15][16][17][18][19]. There is a Case Report [20] that serves as a path forward in the detection of "fentanyls," other novel synthetic opioids (NSO), and novel psychoactive substances (NPS).…”