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Drug Alcohol Depend. 2019 May 1;198:116-120. doi: 10.1016/j.drugalcdep.2019.01.045. Epub 2019 Mar 18.

Trends in fentanyl and fentanyl analogue-related overdose deaths - Montgomery County, Ohio, 2015-2017.

Author information

1
Department of Population and Public Health Sciences, Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Kettering, OH, 45420, USA. Electronic address: raminta.daniulaityte@wright.edu.
2
Montgomery County Coroner's Office/Miami Valley Regional Crime Lab (MCCO/MVRCL), 361 W Third ST., Dayton, OH, 45402, USA.
3
Department of Chemistry, College of Science and Mathematics, Wright State University, 202 Oelman Hall, Dayton, OH, 45435, USA.
4
Department of Population and Public Health Sciences, Center for Interventions, Treatment, and Addictions Research, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Kettering, OH, 45420, USA.
5
Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Kettering, OH, 45420, USA; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, 627 S. Edwin C. Moses Blvd., Suite 1 Dayton, OH, 45417, USA.
6
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY, 10032, USA.

Abstract

INTRODUCTION:

There is a lack of information on illicitly manufactured fentanyl and fentanyl analogue-related (IMF) unintentional overdose death trends over time. The study analyzes IMF-related unintentional overdose fatalities that occurred between July 2015 and June 2017 in Montgomery County, Ohio, an area with the highest rates of unintentional overdose mortality in Ohio.

METHODS:

LC-MS/MS-based method was used to identify fentanyl analogs and metabolites in 724 unintentional overdose death cases. The Chi-square statistic was used to assess differences over time in demographic and drug-related characteristics.

RESULTS:

The number of unintentional overdose death cases testing positive for IMFs increased by 377% between second half of 2015 and first half of 2017. The majority of decedents were white (82.5%) and male (67.8%). The proportion of fentanyl-only (no other analogs) cases declined from 89.2%-24.6% (p < 0.001), while proportion of fentanyl analogue-containing cases increased from 9.8%-70.3% (p < 0.001) between the second half of 2015 and first half of 2017. The most commonly identified fentanyl analogs were carfentanil (29.7%), furanyl fentanyl (14.1%) and acryl fentanyl (10.2%). Proportion of IMF cases also testing positive for heroin declined from 21.6% to 5.4% (p < 0.001), while methamphetamine positive cases increased from 1.4%-17.8% (p < 0.001) over the same time period.

DISCUSSION:

Emergence of fentanyl analogs contributed to substantial increases in unintentional overdose deaths. The data indicate a growing overlap between the IMF and methamphetamine outbreaks. Continuous monitoring of local IMF trends and rapid information dissemination to active users are needed to reduce the risks associated with IMF use.

KEYWORDS:

Carfentanil; Fentanyl; Fentanyl analogs; Illicitly manufactured fentanyl; Ohio; Unintentional overdose deaths

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