Increases in Fentanyl-Related Overdose Deaths — Florida and Ohio, 2013–2015

TLDR

Fentanyl, a synthetic opioid 50–100 times more potent than morphine, is increasingly produced illicitly as IMF and was identified by the DEA and CDC in 2015 as a major public health threat. This study reports on the rise of fentanyl‑related overdose deaths in Florida and Ohio from 2013 to 2015 and investigates how trends in law‑enforcement fentanyl submissions relate to those deaths, highlighting at‑risk populations. Using the National Forensic Laboratory Information System to track fentanyl submissions and medical examiner/coroner data to identify deaths, the authors analyzed temporal associations and risk factors. The analysis shows that fentanyl deaths in Florida and Ohio surged during 2013–2015, mirroring parallel increases in fentanyl submissions, disproportionately affecting heroin users, and in Ohio were linked to mental‑health diagnoses and recent institutional release.

Abstract

In March and October 2015, the Drug Enforcement Administration (DEA) and CDC issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl (IMF), as a threat to public health and safety (1,2). IMF is pharmacologically similar to pharmaceutical fentanyl (PF), but is unlawfully produced in clandestine laboratories, obtained via illicit drug markets, and includes fentanyl analogs. Fentanyl is a synthetic opioid 50-100 times more potent than morphine and approved for the management of surgical/postoperative pain, severe chronic pain, and breakthrough cancer pain. * DEA's National Forensic Laboratory Information System (NFLIS) collects drug identification results from drug cases analyzed by federal, state, and local forensic laboratories throughout the United States.(†) In 2014, 80% of fentanyl submissions (i.e., drug products obtained by law enforcement that tested positive for fentanyl) in NFLIS were identified from 10 states, including Florida and Ohio (2), and seven of these 10 states reported sharp increases in fentanyl-related overdose deaths (fentanyl deaths) (3). This report presents findings of increased fentanyl deaths during 2013-2015 from investigations conducted by the University of Florida and the Ohio Department of Public Health, in collaboration with CDC. Analyses examined the association between trends in fentanyl-related law enforcement submissions and fentanyl deaths and describes groups at risk for fentanyl death using medical examiner and coroner reports. The marked increases in fentanyl death in Florida and Ohio during 2013-2015 were closely associated with parallel increases in fentanyl submissions, with the largest impact on persons who use heroin, consistent with reports that IMF is commonly mixed with or sold as heroin (1,4). In Ohio, circumstances associated with fentanyl deaths included a current diagnosed mental health disorder(§) and recent release from an institution such as a jail, rehabilitation facility, or hospital.