From 2013 to 2014, law enforcement encounters (drug submitted for analysis) testing positive for fentanyl sharply increased in a growing number of states, according to two new articles published today in CDC’s Morbidity and Mortality Weekly Report. Synthetic opioid-involved overdose deaths including fentanyl have also increased in multiple states. Recent investigations in Ohio and Florida provide strong evidence that increases in fentanyl deaths do not involve prescription fentanyl but are primarily related to illicitly-made fentanyl. Illicitly-made fentanyl is often mixed with or sold as heroin—with or without the users’ knowledge and increasingly distributed in counterfeit pills.
Key findings from 2013 to 2014
- Law enforcement fentanyl encounters in the U.S. quadrupled.
- Synthetic opioid-involved deaths in the U.S. increased by nearly 80%, and these were likely driven by fentanyl-involved overdose deaths.
- Fentanyl prescription rates remained relatively stable.
- High-burden states show that all demographic groups had substantial increases in synthetic opioid-involved deaths, and the emerging patterns mirror the evolving demographics of those using heroin.
- In Florida and Ohio, both high burden states,
- Law enforcement fentanyl encounters and fentanyl-involved overdose deaths increased significantly.
- Fentanyl prescription rates increased only slightly (Florida) or declined slightly (Ohio).
- Fentanyl-involved overdose death rates were highest among persons aged 26-34 and 35-50 in Florida and 25-44 in Ohio. Rates were also highest among males and whites.
- The percentage of fentanyl-involved overdoses testing positive for other illicit substances increased significantly in Florida, specifically cocaine and heroin.
Why is this topic important?
The current fentanyl crisis continues to expand in size and scope across the United States. The toxicity of fentanyl and possibility of rapid death, coupled with the extremely sharp one-year increase in synthetic opioid-involved overdose deaths including fentanyl, highlight the urgent need to understand the factors driving this increase. Urgent public health action is needed to: 1) improve timeliness of opioid surveillance to facilitate faster identification and response to spikes in fentanyl overdoses, 2) expand evidence-based harm reduction and naloxone access, with a focus on persons using heroin, and 3) implement programs that increase linkage and access to medication-assisted treatment, with a focus on persons using heroin.
- Gladden RM, Martinez P, Seth P. Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid–Involved Overdose Deaths — 27 States, 2013–2014. MMWR 2016; 65(33);837-843.
- Peterson AB and Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, Halpin J, Zibbell J, McCarty CL, DeFiore-Hyrmer J, DiOrio, M, and Goldberger B. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2010-2015. MMWR 2016; 65(33);844-849.
- International Overdose Awareness Day: August 31, 2016. http://www.overdoseday.com
- Centers for Disease Control and Prevention (August 24, 2016). "Reported Law Enforcement Encounters Testing Positive for Fentanyl Increase Across US." http://www.cdc.gov/
- Centers for Disease Control and Prevention (August 25, 2016). "HAN Update: Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds Further Increases Risk of Fentanyl-related Overdose and Fatalities." https://emergency.cdc.gov/han/
- Centers for Disease Control and Prevention (October 26, 2015). "CDC Health Advisory: Increases in fentanyl drug confiscations and fentanyl-related overdose fatalities."http://emergency.cdc.gov/han/
- Drug Enforcement Administration (March 8, 2015). “DEA Issues Nationwide Alert on Fentanyl as Threat to Health and Public Safety.” http://www.dea.gov/divisions/