Synthetic Fentanyl Fueling Surge in Overdose Deaths: CDC

U.S. Surgeon General urges doctors to join the fight against opioid addiction epidemic

Thursday, August 25, 2016

THURSDAY, Aug. 25, 2016 (HealthDay News) -- Deaths from overdoses of the synthetic narcotic fentanyl have surged in recent years, U.S. health officials say in a troubling new report.

As more fentanyl was sold illegally on the streets, the number of fatal overdoses jumped 79 percent in 27 states from 2013 to 2014, the government report found, while law enforcement seizures of the drug increased 426 percent in eight of those 27 states.

"Fentanyl is a powerful opioid that is 50 to 100 times more potent than morphine, and it is available by prescription, but evidence indicates that illicitly made fentanyl is more likely a powder mixed with heroin and or sold as heroin," said report author R. Matthew Gladden. He's a behavioral scientist at the U.S. Centers for Disease Control and Prevention.

The fentanyl crisis is being driven by products made illegally, not by the diversion of prescription fentanyl, Gladden noted.

Recently, the U.S. Drug Enforcement Administration reported that synthetic fentanyl was showing up mixed with prescription narcotic painkillers, and "this is a new and emerging threat," Gladden said.

Most of the victims of these overdoses were men and those aged 15 to 44, the researchers reported.

Eight states from the 27 studied were more dramatically affected than the others: Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.

In those states, the synthetic opioid death rate (mostly fentanyl) jumped 174 percent during 2013-2014, the researchers said.

In addition, seven states reported an increase of more than 100 deaths in 2013-2014 tied to synthetic opioids (mostly fentanyl), the authors said.

The report was published Aug. 26 in the CDC's Morbidity and Mortality Weekly Report.

"The sharp increase in overdose deaths indicates a need for an urgent response, not just in the states that are currently impacted but in other states, because the problem seems to be spreading and taking on new dimensions," Gladden said.

For example, heroin spiked with fentanyl may be responsible for 75 overdoses in Indiana and Ohio since last Friday. More than 30 overdoses occurred in Cincinnati last weekend, with 33 more overdoses -- including one death -- in the city since Tuesday. Authorities responded to 14 overdoses -- including one death -- late Tuesday and early Wednesday in Jennings County, Ind., USA Todayreported.

But one expert noted even more deadly compounds might have been added to those drugs.

"It's likely that the heroin being distributed on the streets in the recent string of overdoses in Cincinnati may have contained such illicitly manufactured compounds as carfentanil and a drug known as W-18," said Dr. Robert Glatter. He's an emergency physician at Lenox Hill Hospital in New York City.

Both compounds are most likely manufactured in China and sold online to dealers in the United States, who use them to produce the heroin and fake Oxycontin pills they sell on the street, he said.

Carfentanil, which is used as an elephant tranquilizer, and W-18 are nearly 10,000 times more potent than morphine, he noted. And W-18 is almost 100 times more potent than fentanyl, Glatter added.

"People who buy heroin from dealers on the street may not even be aware that they are taking the drug," he said. "Dealers often cut their heroin with such synthetic drugs to make their supply last longer, while also making it more potent."

In a separate MMWR report, researchers honed in on Florida and Ohio. In Florida, drug seizures rose 494 percent, and deaths rose 115 percent. In Ohio, they rose by 1,043 percent and 526 percent, respectively.

According to Gladden, a multi-pronged approach is needed to quell the fentanyl epidemic.

"We need to get information about these overdoses, so we can respond faster with more knowledge," he said.

In addition, availability of naloxone (Narcan), which can reverse the effects of a narcotic overdose, has to be increased, "so people can get treatment as quick as possible to save their lives," Gladden said.

However, fentanyl is so toxic that a single dose of naloxone might not be enough to reverse an overdose, so patients or bystanders should call 911 in the event of an overdose, he said.

Gladden believes doctors need to be cautious about prescribing narcotics for pain, because it's important to prevent abuse and addiction in the first place.

U.S. Surgeon General Dr. Vivek Murthy is also hoping to prevent addiction from occurring. For the first time ever, the Surgeon General is sending a letter to all practicing physicians in the country urging them to educate themselves on the safer prescribing of opioid painkillers to lessen the risk of addiction.

"We arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely," Murthy wrote.

"Many of us were even taught -- incorrectly -- that opioids are not addictive when prescribed for legitimate pain," Murthy said. "The results have been devastating."

SOURCES: R. Matthew Gladden, Ph.D., behavioral scientist, U.S. Centers for Disease Control and Prevention; Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; Harshal Kirane, M.D., director, addiction services, Staten Island University Hospital, New York City; USA Today; Vivek Murthy, M.D., U.S. Surgeon General; Aug. 26, 2016, Morbidity and Mortality Weekly Report

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