CDC: Synthetic Opioid Deaths on the Rise, Urgent Public Health Response Needed

The CDC report studied the number of drug products obtained by the DEA that tested positive for fentanyl
The CDC report studied the number of drug products obtained by the DEA that tested positive for fentanyl

During 2013–2014, the nubmer of fentanyl submissions increased by 426% and the number of synthetic opioid deaths increased by 79%, according to a report in the Centers for Disease Control and Prevention (CDC)'s Morbidity and Mortality Weekly Report.

The production and distribution of illicitly manufactured fentanyl (IMF) substantially increased beginning in 2013. Multiple states have reported increases in fentanyl-involved overdose deaths (fentanyl deaths).  In 2015, the Drug Enforcement Agency (DEA) and CDC issued nationwide communications identifying IMF as a public health threat. A recent report in the CDC's Morbidity and Mortality Weekly Report studied the number of drug products obtained by law enforcement that tested positive for fentanyl (fentanyl submissions) and synthetic opioid-involved deaths other than methadone (synthetic opioid deaths), including fentanyl deaths and deaths involving other synthetic opioids (eg, tramadol).  

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Specifically, the number of fentanyl submissions increased from 1,015 to 5,343 and the number of synthetic opioid deaths increased from 3,105 to 5,544, in 2013–2014. Fentanyl prescription rates, however, remained relatively stable. Among the 27 states with consistent death certificate reporting of drugs involved in overdoses, fentanyl submission increases were strongly associated with increases in synthetic opioid deaths (r=0.95). Changes in fentanyl submissions and synthetic opioid deaths were not associated with changes in fentanyl prescribing rates.

Moreover, increases in fentanyl submissions and synthetic opioid deaths were primarily concentrated in 8 "high-burden" states (174% increase): Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland, and North Carolina. Data from 6 of these 8 states indicated that fentanyl-involved overdose deaths were mainly fueling increases in synthetic opioid deaths, further supporting the argument that IMF is driving increases in fentanyl deaths. For the high-burden states, all demographic groups demonstrated substantial increases in synthetic opioid death rates. Persons aged 15–24 years (347%), persons aged 25–34 years (248%), and Hispanics (290%) saw the highest increases. 

Authors of the report call for an "urgent, collaborative public health and law enforcement response." Specifically, efforts should focus on:

  • Improving timeliness of opioid surveillance to facilitate faster identification and response to spikes in fentanyl overdoses; 
  • Expanding testing for fentanyl and fentanyl analogues in high-burden states;
  • Expanding evidence-based harm reduction and naloxone access;
  • Implementing programs that increase linkage and access to medication-assisted treatment; 
  • Increasing collaboration between public health and public safety; and
  • Planning rapid response in high-burden states and states beginning to experience increases in fentanyl submissions or deaths 

For more information visit CDC.gov.

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