Overdose Deaths Related to Fentanyl and Its Analogs — Ohio, January–February 2017

Daniulaityte, Raminta; Juhascik, Matthew P.; Strayer, Kraig E.; Sizemore, Ioana E.; Harshbarger, Kent E.; Antonides, Heather M.; Carlson, Robert R.

doi:10.15585/mmwr.mm6634a3

Cited by 98 publications

(76 citation statements)

References 7 publications

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“…15 Multiple parenteral doses of naloxone (i.e., 0.4 mg up to 2 mg) may be administered and repeated every 3-5 minutes, escalated to a total dose of 10 mg and guided by restoration of normal respirations. [15][16][17] Importantly, support of ventilation and oxygenation should take precedence over naloxone administration, 15 as was the case in our report.…”

Section: Discussionmentioning

confidence: 84%

“…For example, in the case report described earlier, our screen for opioids only targeted morphine, codeine, and heroin, and our patient's findings were all negative for these substances.Carfentanil is currently not identified with available immunoassay screening assays for opioids. Others have called for the urgent need to test for a number of illicitly manufactured fentanyl analogs as part of standard toxicology panels . All drug screens based on LC–MS/MS systems are targeted and hence are limited to identifying a defined number of drugs and metabolites in a patient's blood or urine.…”

Section: Discussionmentioning

confidence: 99%

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The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report

et al. 2018

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Carfentanil and related fentanyl analogs have been linked to a number of overdose deaths from drug users in several cities across North America. Diagnosis of carfentanil exposure requires a very high index of clinical suspicion, especially because available laboratory narcotic screens do not detect this agent. We describe a 34-year-old man admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil. Urine and whole blood samples were obtained for conventional preliminary drug screen immunoassays for unknown exposures, in addition to utilizing a high-pressure liquid chromatography-tandem mass spectrometry assay for quantification of carfentanil and its metabolite. The patient was intubated and required mechanically assisted ventilation for 31 hours until he was able to breathe safely on his own. Pharmacokinetic modeling of three timed blood samples identified the elimination half-life as 5.7 hours for carfentanil and 11.8 hours for the norcarfentanil metabolite. Awakening and breathing spontaneously corresponded to an interpolated blood carfentanil concentration of 0.52 ng/ml. This is the first pharmacokinetic and pharmacodynamic case report on the recreational use of carfentanil. Critical care clinicians should anticipate long periods of ventilatory support in the care of patients exposed to carfentanil.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report

et al. 2018

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“…Fentanyl and fentanyl analogs are highly potent and fast-acting synthetic compounds that can trigger rapid progression to loss of consciousness and death and thus might require immediate treatment and high doses of naloxone ( 5 ). Because of the potency of fentanyl and fentanyl analogs and the rapid onset of action, these drugs were determined by medical examiners and coroners to play a causal role in almost all fatal opioid overdoses in which they were detected.…”

Section: Discussionmentioning

confidence: 99%

“…Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase ( 3 , 4 ). In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths ( 5 , 6 ) and the illicit opioid drug supply ( 7 ). Carfentanil is estimated to be 10,000 times more potent than morphine ( 8 ).…”

mentioning

confidence: 99%

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

O’Donnell¹,

Halpin²,

Mattson³

et al. 2017

MMWR Morb. Mortal. Wkly. Rep.

336

242

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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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Overdose Deaths Related to Fentanyl and Its Analogs — Ohio, January–February 2017

Cited by 98 publications

References 7 publications

The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report

The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report

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

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