Opioid Deaths in Milwaukee County, Wisconsin 2013‐2017: The Primacy of Heroin and Fentanyl

Abstract

Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non-natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.

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

“…The increase in fentanyl-related fatalities observed in this population in the last several years appears to reflect similar patterns observed more recently in the Western regions of the US [28,36].…”

“…Although fentanyl analogs, such as furanyl fentanyl, methoxyacetyl fentanyl, and carfentanil, were detected in 2017 ( n = 16) and 2018 ( n = 9), the number of these cases decreased markedly in our population following the fentanyl‐core scheduling in 2018 [11]. These cases were primarily detected without heroin and/or fentanyl, which contrasted with reports out of the Northeast and Midwest regions at that time [28–30] likely due to differences in the heroin drug supply. Powdered heroin during this time was frequently adulterated with fentanyl and fentanyl analogs in the Northeast and Midwest [34–36].…”

“…The opioid epidemic continues to pose a significant threat to the public nationwide and globally. Since approximately 2015, significant increases in fentanyl-related fatalities have been reported nationwide [21,[26][27][28][29][30][31], but especially in the Northeast and Midwest regions of the US [21,29]. Only recently has more toxicological information been published on the emergence of fentanyl and significant increases in fentanyl-related deaths in the Western [21,28,31] and Southern [27,32,33] regions of the US.…”

Proliferation of Novel Synthetic Opioids in Postmortem Investigations After Core-Structure Scheduling for Fentanyl-Related Substances

“…The US Centers for Disease Control and Prevention estimate that there will be more than 100,000 opioid deaths in 2021 17 . Illicit drug manufacturers have continued to introduce a variety of novel opioid agonist structural classes with varying potencies, which have been contributory and/or causal agents in nonfatal and fatal overdoses 18–38 . Between 2015 and 2018, most NSO-classified novel psychoactive substances (NPSs) infiltrating the illicit drug market were fentanyl analogs, such as 2-furanylfentanyl, carfentanil, acrylfentanyl, methoxyacetylfentanyl, and cyclopropylfentanyl 39–60 .…”

Green Hope: Perspectives on Cannabis from People who Use Opioids

“…The overdose death rates for 2018 decreased for the first time since the 1990s, although a surge of fentanyl overdose deaths suggests that the crisis is not over (O'Donnell, John Halpin, and Mattson 2017; Peterson et al. 2019). While increased distribution of naloxone, an opioid antagonist that can reverse an opioid overdose, has contributed to lower overdose death rates, studies indicate that more diverse prevention and intervention strategies are needed to effectively combat this ongoing crisis (Boeri and Lamonica forthcoming; Langabeer et al.…”