Fentanyl-associated Fatalities Among Illicit Drug Users in Wayne County, Michigan (July 2005–May 2006)
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During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroin-associated fatalities (FHFs) with non-fentanyl, heroin-associated fatalities (NFHFs) among illicit drug users.
Baseline prevalence of fentanyl- and heroin-associated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status.
Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p = 0.003). Women aged over 44 years (OR = 4.67;95 % CI = 1.29–16.96) and divorced/widowed women (OR = 14.18;95 % CI = 1.59–127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n = 96; 95 %): fentanyl was detected in most (n = 91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n = 37; 40.7 %). About half of these samples had detectable cocaine concentrations (n = 20; 54 %). Median fentanyl concentration in central blood samples was 0.02 μg/ml (n = 91, range <0.002–0.051 μg/ml) and 0.02 μg/ml (n = 32, range <0.004–0.069 μg/ml) in peripheral blood samples. The geometric mean of the ratio of central to peripheral values was 2.10 (median C/P = 1.75). At autopsy, pulmonary edema was the most frequently encountered finding for both groups (77 %).
Illicit drugs may contain undeclared ingredients that may increase the likelihood of fatality in users. Gender differences in fentanyl-related mortality may be modified by age and/or marital status. These findings may help inform public health and prevention activities if fatalities associated with fentanyl-contaminated illicit drugs reoccur.
- Poklis A (1995) Fentanyl: a review for clinical and analytical toxicologists. J Toxicol Clin Toxicol 33:439–447 CrossRef
- Henderson GL (1991) Fentanyl-related deaths: demographics, circumstances, and toxicology of 112 cases. J Forensic Sci 36:422–433
- Hibbs J, Perper J, Winek CL (1991) An outbreak of designer drug-related deaths in Pennsylvania. JAMA 265:1011–1013 CrossRef
- Smialek JE, Levine B, Chin L, Wu SC, Jenkins AJ (1994) A fentanyl epidemic in Maryland 1992. J Forensic Sci 39:159–164
- MMWR (2008) Nonpharmaceutical fentanyl-related deaths—multiple states, April 2005-March 2007. MMWR 57(29):793–6
- Boddiger D (2006) Fentanyl-laced street drugs “kill hundreds”. Lancet 368:569–570 CrossRef
- A look at a drug cocktail problem around the country. (2006, May 27). The Associated Press News Service
- Karush S (2006) Bad heroin sparks a series of overdoses. The Associated Press News Service
- County Medical Examiners (Excerpt) Act of 1953. Michigan legislature. Available at: http://legislature.mi.gov/doc.aspx?mcl-52-202. Accessed on 9/29/2011.
- Martin M, Hecker J, Clark R et al (1991) China white epidemic: an eastern United States emergency department experience. Ann Emerg Med 20:158–164 CrossRef
- Kronstrand R, Henrik D, Holmgren P, Rajs J (1997) A cluster of fentanyl-related deaths among drug addicts in Sweden. Forensic Sci Int 88:185–195 CrossRef
- Fillingim RB, Gear RW (2004) Sex differences in opioid analgesia: clinical and experimental findings. Eur J Pain 8:413–425 CrossRef
- Darke S, Hall W (2003) Heroin overdose: research and evidence-based intervention. J Urban Health 80:189–200 CrossRef
- Baca CT, Grant KJ (2005) Take-home naloxone to reduce heroin death. Addiction 100:1823–1831 CrossRef
- Sporer KA, Kral AH (2007) Prescription naloxone: a novel approach to heroin overdose prevention. Ann Emerg Med 49:172–177 CrossRef
- McGregor C, Darke S, Christie P, Ali R (1998) Experience of non-fatal overdose among heroin users in Adelaide: circumstances and risk perception. Addiction 93:701–711 CrossRef
- Strang J, Best D, Man L, Noble A, Gossop M (2000) Peer-initiated overdose resuscitation: fellow drug users could be mobilised to initiate resuscitation. Int J Drug Policy 11:437–445 CrossRef
- Davidson PJ, McLean RL, Kral AH, Gleghorn AA, Edlin BR, Moss AR (2003) Fatal heroin-related overdose in San Francisco, 1997–2000: a case for target intervention. J Urban Health 80:261–273 CrossRef
- Darke S, Ross J, Zador D, Sunjic S (2000) Heroin-related deaths in New South Wales, Australia, 1992–1996. Drug Alcohol Depend 60:141–150 CrossRef
- McGregor C, Ali R, Lokan R, Christie P, Darke S (2002) Accidental fatalities among heroin users in South Australia, 1994–1997: toxicological findings and circumstances of death. Addict Res 10:335–346 CrossRef
- Baselt RC (2011) Disposition of toxic drugs and chemicals in man: fentanyl. Biomedical Publications, Seal Beach, pp 675–8
- Turock MK, Watts DJ, Mude H, Prestosh J, Stoltzfus J (2009) Fentanyl-laced heroin: a report from an unexpected place. Am J Emerg Med 27(2):237–239 CrossRef
- Fernando D (1991) Fentanyl-laced heroin. JAMA 265(22):2962 CrossRef
- Henderson GL, Harkey MR, Jones AD (1990) Rapid screening of fentanyl (China white) powder samples by solid-phase radioimmunoassay. J Anal Toxicol 14:172–175 CrossRef
- Silverstein JH, Rieders MF, McMullin M, Schulman S, Zahl K (1993) An analysis of the duration of fentanyl and its metabolites in urine and saliva. Anesth Analg 76:618–621
- Heit HA, Gourlay DL (2004) Urine drug testing in pain medicine. J Pain Symptom Manage 27:260–267 CrossRef
- Drug Abuse Warning Network. Available at: http://dawninfo.samhsa.gov. Accessed on 9/29/2011.
- Wolkin AF, Martin CA, Law RK, Schier JG, Bronstein AC. Using poison center data for national public health surveillance for chemical and poison exposure and associated illness. Ann Emerg Med. 2011 Sep 19. [Epub ahead of print]
- Fentanyl-associated Fatalities Among Illicit Drug Users in Wayne County, Michigan (July 2005–May 2006)
Journal of Medical Toxicology
Volume 9, Issue 1 , pp 106-115
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- Springer US
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- Author Affiliations
- 1. Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Health Studies Branch, Atlanta, GA, USA
- 2. Office of the Wayne County Medical Examiner, Detroit, MI, USA
- 3. Michigan Department of Community Health, Bureau of Epidemiology, Lansing, MI, USA
- 4. Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA, USA