Trends in and Characteristics of Drug Overdose Deaths Involving Illicitly Manufactured Fentanyls — United States, 2019–2020

Misinterpretation of the “Overdose Crisis” Continues to Fuel Misunderstanding of the Role of Prescription Opioids

“…1 There are a variety of factors that have influenced the progressive pacing of opioid-related overdoses witnessed throughout the second decade of the 21st century. Perhaps the most significant has been the introduction and availability of illicitly manufactured synthetic opioid products (namely “fentalogues”), 2 , 3 although additional contributors include increasing rates of polysubstance abuse, 2–5 continued poor access to medication assisted treatments and behavioral health supports, 6 and restrictions and reductions of legitimate opioid access when clinically indicated. 7–11 …”

“… 14 It is well-accepted in scientific circles that current overdose deaths involve fentanyl-related compounds that are illicitly manufactured and not FDA approved pharmaceutical fentanyl (or its FDA approved chemical derivatives alfentanil, remifentanil, and sufentanil) used in both acute and chronic settings. 2 , 14 , 15 This is a distinction that must be accurately described in order to diminish untoward apprehension in prescribing pharmaceutical fentanyl and its related compounds safely in a both monitored clinical settings and for home use.…”

“…Adding to the lack of clarity resulting from such mislabeling of “prescription opioid deaths” is that the majority of drug overdose deaths appear to involve more than one substance. 2–5 , 14 Drug deaths involving polysubstances propagate spurious correlations and false narratives regarding which drug or drugs contributed to the actual death. When one examines toxicology reports, multiple drugs are generally found postmortem in the deceased, particularly when an opioid is involved.…”

“…It is stated that “prescription opioid deaths” have continuously increased from “1999 through 2017”, yet more recent data indicate that natural and semisynthetic opioid overdose deaths (to which they refer as “prescription opioid deaths”) have been stable or declining since 2015. 1 , 2 , 27 Seth et al determined that longitudinal trends indicated a rapid increase in death rates involving synthetic opioids from 2013–2016 vs death rates involving natural and semisynthetic opioids, which remained relatively stable from 2009–2016, with an annual percent increase of 3.4%. 27 More recently, particularly throughout the COVID-19 pandemic which has increased isolation and limited access to healthcare providers, overdose deaths have continued to increase dramatically.…”

Commentary on Skulberg et al.: Naloxone administration—finding the balance

“…Duration of sufficient response is related to both dose and route of administration, [13, 14] and a short duration of action risks the possibility of recurrent respiratory depression. This issue has significant implications for the high numbers of illicit fentanyl overdoses occurring in North America [15]. Such overdoses can occur within minutes, and reports of their resistance to reversal despite regular doses of naloxone have been recorded [14].…”