Fentanyl shock: The changing geography of overdose in the United States

Zoorob, Michael

doi:10.1016/j.drugpo.2019.04.010

Cited by 118 publications

(95 citation statements)

References 25 publications

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“…Between 1990 and 2016, the total number (age standardised prevalence) of people dependent on opioids increased from 18.2 million (360.8 per 100 000) to 26.8 million (353.0 per 100 000), resulting in 86 200 deaths and 36.6 million years of life lost in 2016 1. In North America, the introduction of illicitly manufactured fentanyl and other highly potent, synthetic opioids in the drug supply has contributed to a rapidly worsening disease burden 234567. In Canada, an unprecedented 4614 opioid related deaths occurred in 2018, with nearly three quarters of these deaths involving fentanyl or other synthetic opioids 8.…”

Section: Introductionmentioning

confidence: 99%

Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

Pearce

Min

Piske

et al. 2020

BMJ

146

128

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Objective To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. Design Population based retrospective cohort study. Setting Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada. Participants 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018. Main outcome measures All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply. Results 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk). Conclusions Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

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Section: Introductionmentioning

confidence: 99%

Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

Pearce

Min

Piske

et al. 2020

BMJ

146

128

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“…In the last decade, the general situation and world distribution of drugs of abuse has evolved dramatically with the emergence of a large variety of new psychoactive substances (NPS). In particular, the pattern of abused synthetic opioids progressed from the over-prescription of legal analgesic drugs such as hydrocodone, oxycodone, and fentanyl, to the clandestine synthesis of new fentanyl derivatives specifically produced for the illegal market [1,2]. Fentanyl and its analogues are considered particularly risky for their extreme pharmacological effects, as the large and ever-increasing outburst of lethal overdose cases in the USA clearly evidences [3].…”

Section: Introductionmentioning

confidence: 99%

Targeted and untargeted detection of fentanyl analogues and their metabolites in hair by means of UHPLC-QTOF-HRMS

Salomone

Corcia²,

Negri³

et al. 2020

Anal Bioanal Chem

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Detection of new psychoactive substances and synthetic opioids is generally performed by means of targeted methods in mass spectrometry, as they generally provide adequate sensitivity and specificity. Unfortunately, new and unexpected compounds are continuously introduced in the illegal market of abused drugs, preventing timely updating of the analytical procedures. Moreover, the investigation of biological matrices is influenced by metabolism and excretion, in turn affecting the chance of past intake detectability. In this scenario, new opportunities are offered by both the non-targeted approaches allowed by modern UHPLC-HRMS instrumentation and the investigation of hair as the matrix of choice to detect long-term exposure to toxicologically relevant substances. In this study, we present a comprehensive and validated workflow that combines the use of UHPLC-QTOF-HRMS instrumentation with a simple hair sample extraction procedure for the detection of a variety of fentanyl analogues and metabolites. A simultaneous targeted and untargeted analysis was applied to 100 real samples taken from opiates users. MS and MS/MS data were collected for each sample. Data acquisition included a TOF-MS high-resolution scan combined with TOF-MS/MS acquisition demonstrating considerable capability to detect expected and unexpected substances even at low concentration levels. The predominant diffusion of fentanyl was confirmed by its detection in 68 hair samples. Other prevalent analogues were furanylfentanyl (28 positive samples) and acetylfentanyl (14 positive samples). Carfentanil, methylfentanyl, and ocfentanil were not found in any of the analyzed samples. Furthermore, the retrospective data analysis based on untargeted acquisition allowed the identification of two fentanyl analogues, namely β-hydroxyfentanyl and methoxyacetylfentanyl, which were not originally included in the panel of targeted analytes.

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“…15,16 There are also pronounced regional disparities in the use of prescription opioids. 13,14,17,18 A fivefold difference was identified between the highest (Rhode Island) and lowest (South Dakoda) states. 4 Drug overdoses are much higher in the Eastern US, compared to the Western US, although several Western states have recently seen significant increases in overdose deaths 18,19 Half of counties, including over two-thirds in rural areas, lacked a single OUD medication provider.…”

mentioning

confidence: 99%

“…13,14,17,18 A fivefold difference was identified between the highest (Rhode Island) and lowest (South Dakoda) states. 4 Drug overdoses are much higher in the Eastern US, compared to the Western US, although several Western states have recently seen significant increases in overdose deaths 18,19 Half of counties, including over two-thirds in rural areas, lacked a single OUD medication provider. 20 The prevalence of waivered physicians in 2013 differed sixteen-fold between the highest (Vermont) and lowest (Iowa) states.…”

mentioning

confidence: 99%

Rise and Regional Disparities in Buprenorphine Utilization in the United States

Pashmineh

Cruz-Mullane

Podd

et al. 2019

Preprint

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Aims: Buprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution. Measurements: Buprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined. Findings: Buprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state (r(49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018. Conclusions: Although buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.

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Fentanyl shock: The changing geography of overdose in the United States

Cited by 118 publications

References 25 publications

Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

Targeted and untargeted detection of fentanyl analogues and their metabolites in hair by means of UHPLC-QTOF-HRMS

Rise and Regional Disparities in Buprenorphine Utilization in the United States

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