Fentanyl Deaths

Drug overdose deaths in the United States are estimated to have exceeded 60,000 in 2016. More than 20,000 of these deaths were attributed to synthetic opioids, especially illicitly manufactured fentanyl. Fentanyl is 50 to 100 times more potent than morphine. Fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths. Carfentanil was originally intended for sedation of large animals and is estimated to be 10,000 times more potent than morphine. The use of illicitly manufactured fentanyl mixed with heroin, with and without users’ knowledge, is responsible for many fentanyl overdoses. Many of patients who died also test positive for heroin, cocaine or methamphetamine.

Fentanyl and fentanyl analogs are highly potent synthetic compounds that are rapidly absorbed and have high bioavailability. Because of these properties, they can quickly cause respiratory depression, loss of consciousness and death. Injection is the most commonly reported route of administration in fatal overdoses, but because of their high potency other routes of administration such as snorting, ingestion, or smoking can also lead to death. Overdoses should be treated immediately with naloxone injection.

The prevalence of fentanyl analogs is underestimated because commonly used toxicologic testing does not include fentanyl analogs. Routine toxicology screens for opiates will not detect fentanyl or its analogs. Detection of fentanyl analogs requires specialized toxicology testing such as liquid chromatography/tandem mass spectrometry (LC/MS-MS).

Reference
O’Donnell, JK et al. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR, Nov 3, 2017;66(43):1197-1202.
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