Killer drug

Killer drug

Fentanyl-related overdose deaths have increased rapidly in Florida since 2010

By Elizabeth Hillaker Downs

98460311-1Florida has seen a sharp increase in fentanyl-related overdose deaths over the past five years, according to UF Health researchers who recently co-authored a Centers for Disease Control and Prevention report.

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine, and it is available via prescription to treat surgical, cancer-related and chronic pain. However, the deaths appear to stem from illicitly manufactured fentanyl, which is made in clandestine laboratories and is often mixed with other drugs, such as heroin, without buyers’ knowledge.

According to the CDC’s Morbidity and Mortality Weekly Report, Florida is one of eight states of the 27 analyzed that saw substantial increases, especially among people ages 14-34, followed by people ages 35-50, males and whites. From 2010-2012 to 2013-2014, the total number of people in Florida who died from fentanyl-related overdoses increased from 379 to 582, and the number of people ages 14-34 increased from 82 to 200. The first half of 2015 is on track to far surpass the previous four years, with 289 deaths statewide from January to June 2015, which is the most recent data available. See the table below for additional details.

Both fentanyl-related deaths and the number of drug submissions that tested positive for fentanyl followed a similar overall pattern in Florida, with gradual increases from May-November 2014 and a sharp increase during December 2014-February 2015, followed by a return to rates seen between July-November 2014 during March-June 2015. The drug submissions are sent by law enforcement nationwide to the National Forensic Laboratory Information System for testing. Researchers believe the strong correlation between the fentanyl-related deaths and the drug submissions that tested positive for fentanyl indicates that the latter could serve as an early warning system; however, more research is needed to understand the reasons behind the fluctuations from 2014-2015.

Florida prescription rates for fentanyl remained relatively stable at a 5 percent increase during this period, indicating that the deaths are likely driven by illicitly manufactured fentanyl. The largest impact is on people who use heroin and cocaine, which is being mixed with fentanyl. In fact, fentanyl-related deaths that tested positive for heroin increased from 0 to 19 percent between 2010-2012 and 2013-2014 and those that tested positive for cocaine increased from 17 to 33 percent.

“What this analysis shows us is that the types of people who are dying from fentanyl overdoses are similar to those dying from heroin in the U.S. Many young people dying from these dangerous drug cocktails may not even realize that they are being exposed to this potent opioid,” said Chris Delcher, Ph.D., an assistant professor in the department of health outcomes and policy in the UF College of Medicine. “A great deal of attention has been placed on reducing medical sources of prescription pain medications. In this case, we noted that increases in fentanyl prescribing could not explain the sharp increases in fentanyl-related deaths. Understanding and detecting illegal manufacturing of fentanyl is key, and public health and law enforcement officials need to work together to deal with this problem.”

The report also recommends enhancing public health support for individuals using heroin, including increased access to both medication-assisted treatment and naloxone, which nullifies the effect of opioid medication and can prevent overdose deaths.

“It is important to note that these numbers are underestimated because not all subjects are tested for fentanyl, and further, laboratories cannot distinguish prescription fentanyl from illicitly manufactured fentanyl,” said Bruce Goldberger, Ph.D., a professor and director of toxicology in the department of pathology, immunology and laboratory medicine in the UF College of Medicine. “We must improve fentanyl death surveillance nationwide in order to make that distinction and alert us more quickly to these serious public health trends.”