Overdose Deaths Involving Synthetic Opioids

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heroin carfentanil fentanyl

According to the CDC, death rates involving synthetic opioids (other than methadone), which include drugs such as tramadol and fentanyl.

  • In 2017, more than 28,000 deaths involving synthetic opioids (other than methadone) occurred in the United States, which is more deaths than from any other type of opioid.
  • Also in 2017, the largest increase in synthetic opioid overdose death rates was in males aged 25-44.
  • Deaths from synthetic opioids significantly increased in 23 states and the District of Columbia from 2016 to 2017.
  • West Virginia, Ohio, and New Hampshire had the highest death rates from synthetic opioids.1

Synthetic opioid overdose death rates (other than methadone) increased across all demographics, county urbanization levels, and numerous states. State reports have indicated that increases in synthetic opioid-involved deaths have been associated with the number of drug submissions obtained by law enforcement that test positive for fentanyl but not with fentanyl prescribing rates. These reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical.2,3,4

There are also fentanyl analogs, such as acetylfentanyl, furanylfentanyl, and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Recent surveillance has also identified other emerging synthetic opioids, like U-47700.5 Estimates of the potency of fentanyl analogs vary from less potent than fentanyl to much more potent than fentanyl, but there is some uncertainty because potency of illicitly manufactured fentanyl analogs has not been evaluated in humans. Carfentanil, the most potent fentanyl analog detected in the U.S., is estimated to be 10,000 times more potent than morphine. 5,6

 

References

  1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. WR Morb Mortal Wkly Rep. ePub: 21 December 2018.
  2. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths – 27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43.
  3. Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2013-2015. Morb Mortal Wkly Rep. 2016;65(33):844-9.
  4. O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903.
  5. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202.
  6. O’Donnell J, Gladden RM, Mattson CL, Kariisa M. Notes from the Field: Overdose Deaths with Carfentanil and Other Fentanyl Analogs Detected – 10 States, July 2016-June 2017. MMWR Morb Mortal Wkly Rep. July 2018. 67(27);767–768.

What is Fentanyl?

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fentanyl citrate

Fentanyl is a synthetic (man-made) opioid 50 times more potent than heroin and 100 times more potent than morphine. There are two types of fentanyl:

  • Pharmaceutical fentanyl is primarily prescribed to manage severe pain, such as with cancer and end-of-life palliative care.
  • Non-pharmaceutical fentanyl is frequently referred to as illicitly manufactured fentanyl (IMF). IMF is often mixed with heroin and/or cocaine or pressed into counterfeit pills—with or without the user’s knowledge.

Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery and in cases of extreme injury.2 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.3 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects.

In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.3,4 Street names for illegally used fentanyl include Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.

Synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States. In 2017, 59.5 percent of opioid-related deaths involved fentanyl compared to 14.3 percent in 2010.

References

  1. https://www.drugabuse.gov/publications/drugfacts/fentanyl
  2. Nelson L, Schwaner R. Transdermal fentanyl: Pharmacology and toxicology. J Med Toxicol.2009;5(4):230-241. doi:10.1007/BF03178274
  3. Garnock-Jones KP. Fentanyl Buccal Soluble Film: A Review in Breakthrough Cancer Pain. Clin Drug Investig.2016;36(5):413-419. doi:10.1007/s40261-016-0394-y
  4. Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration. Fentanyl Fact Sheet. March 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf.
  5. on. Acetyl fentanyl Fact Sheet. July 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/acetylfentanyl.pdf.

Drug Testing for Methamphetamine

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Drug Testing for Methamphetamine

Methamphetamine drug testing entails an analysis of the chemical reaction performed on a biological specimen to detect the presence of methamphetamine metabolites in the person’s body. It can be done using hair, urine, blood, or oral fluid.

The most common drug test administered in the workplace and schools is urine drug testing. Methamphetamine Drug Test Strips are built into instant kits like the 10 Panel CLIA Waived Magenta Dip Card to provide rapid results. When a person has positive drug test results, it means that person has recently used methamphetamine or some other drugs.

Drug testing for methamphetamine helps authorities assess whether or not the person has recently used the drug. This is helpful, especially during forensic investigations. Parents can also administer methamphetamine drug testing through the use of methamphetamine drug test kits to ensure a drug-free family.

Detection Period

Detection period is the timeframe of how long the drugs can be detected in the biological sample. This will vary based on the drugs being tested for and by the person being tested. The detection period depends on the drug class, amount and frequency of use, age, and overall health.

According to LabCorp, for a methamphetamine urine drug test, the detection period is 3 to 5 days; for a hair test it is up to 90 days and for blood and oral fluid, it is within 12 hours.