Fentanyl epidemic in Chicago, Illinois and surrounding Cook County

Abstract

Chicago and surrounding Cook County experienced an outbreak of 342 fentanyl-related deaths between April 2005 and December 2006. The experience demonstrated a clear need for an interdisciplinary approach to identifying, communicating, and managing an outbreak.

Recurrent Respiratory Depression Associated with Fentanyl Transdermal Patch Gel Reservoir Ingestion

“…The outbreak resulted in 100 deaths in California. Since then, outbreaks have surfaced in Pennsylvania, Maryland, Chicago, Sweden, and elsewhere (14)(15)(16)(17).…”

Management of Opioid Analgesic Overdose

“…Information about the toxic effects of opioid analgesic overdose often must be synthesized from case reports, the clinical observations of medical toxicologists, and forensic data. [24][25][26][27][28][29][30][31] The difference between the clinical effects of therapeutic use and poisoning for these selected agents arises from the toxicokinetics of overdose, patterns of abuse, and the variation in drug effects in special populations. The sine qua non of opioid intoxication is respiratory depression, but miosis and stupor are often observed in poisoned patients.…”

“…If there is no abatement in respiratory depression after the administration of 15 mg of naloxone, it is unlikely that the cause of the depression is opioid overdose. 30,31 Reversal of opioid analgesic toxicity after the administration of single doses of naloxone is often transient; recurrent respiratory depression is an indication for a continuous infusion (see the Supplementary Appendix, available with the full text of this article at NEJM .org) or for orotracheal intubation. 53 Naloxone can be administered without compunction in any patient, including patients with opioid dependence.…”

Toxicology from across the pond

“…20 By 2003 nearly 9% of all deaths certified by the New York City medical examiner tested positive for methadone. 21 Comparable trends are reported from other major cities in the US, 22,23 Canada 24 and the UK. 13 Although it is unclear whether some of these deaths represent suicides using drugs of abuse, most authorities believe that the vast majority of fatalities result from unintended dosing errors or other complications of intentional drug use without overt suicidality.…”