DAYTON—A team of researchers led by the Wright State University Boonshoft School of Medicine found that more than 90 percent of unintentional overdose deaths in 24 Ohio counties in January and February 2017 involved fentanyl and fentanyl analogs, while heroin was identified in only about 6 percent of cases.
Evidence from the study indicates the increasing and substantial role of illicitly manufactured fentanyl and the declining presence of heroin and pharmaceutical opioids in overdose fatalities.
The study also found that fentanyl is commonly appearing in combination with other analogs.
Led by Raminta Daniulaityte, Ph.D., associate professor and associate director of the Boonshoft School of Medicine Center for Interventions, Treatment, and Addictions Research (CITAR), Wright State University and the Montgomery County Coroner’s Office/Miami Valley Regional Crime Lab collaborated on a National Institutes of Health/National Institute on Drug Abuse-funded study (NIH R21DA042757) of fentanyl/fentanyl analogs and other drugs identified in 281 unintentional overdose fatalities.
The study was published in the Sept. 1 issue of Morbidity and Mortality Weekly Report, a weekly journal of the Centers for Disease Control and Prevention. The journal highlights public health investigation and provides reports and recommendations derived from science-based research. To view the report, go to http://bit.ly/2xAFdcr. The study begins on page 904.
“Fentanyl is commonly appearing in combination with other analogs, compounds with a molecular structure similar to fentanyl,” Daniulaityte said. “The effects of these drugs are more unpredictable and dangerous. Fentanyl and fentanyl analogs are key contributors to the unintentional drug-related overdose deaths in 24 Ohio counties.”
Pharmaceutical fentanyl is a powerful synthetic opioid pain reliever. While similar to morphine, it is 50 to 100 times more powerful and is used to treat patients with severe pain. The effects include euphoria, drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma and death, according to the National Institute on Drug Abuse.
However, illicitly manufactured fentanyl is produced in clandestine laboratories and includes fentanyl analogs some of which may be of greater potency than fentanyl. Because of the greater potency, multiple naloxone doses are often required to reverse overdoses of illicitly manufactured fentanyl. Illicitly manufactured fentanyl and its analogs have not been part of routine toxicology testing. Consequently, toxicological data on the current outbreak of fentanyl and fentanyl analogs has been limited.
“The findings of our study highlight the urgent need to include testing for fentanyl and fentanyl analogs as a part of standard toxicology panels for biological specimens used by substance abuse treatment centers, criminal justice institutions and medical providers,” she said. “Communities also need to assure that sufficient supplies of naloxone doses are provided to first responders and distributed though community overdose prevention programs to mitigate the effects of opioid overdoses.”
Through the NIH study, a liquid-chromatography-tandem mass spectrometry based method was developed and validated by toxicologists at the Montgomery County Coroner’s Office Toxicology Laboratory and the Department of Chemistry at Wright State University. The new method tested for 25 fentanyl analogs, metabolites and synthetic opioids. Toxicological testing for other drugs, including heroin, pharmaceutical opioids, benzodiazepines, cocaine, methamphetamine, marijuana and alcohol, also was performed.
In the study, males accounted for 181 of the unintentional overdose deaths. More than half of the deaths occurred in people ages 25 through 44. Only 6 percent of decedents tested positive for heroin. Percentage of heroin positive cases was greater in Appalachian counties. Among the 16 heroin-positive cases, 12 also tested positive for illicitly manufactured fentanyl. Twenty-one people who died, including 11 in Montgomery County, tested positive for carfentanil, a highly toxic IMF compound, which is about 10,000 times more potent than morphine. Carfentanil is used in veterinary medicine for large animals.
In addition to Daniulaityte, the research team includes Matthew P. Juhascik, Ph.D., chief toxicologist, Montgomery County Coroner’s Office/Miami Valley Regional Crime Lab; Kraig E. Strayer, graduate student, Department of Chemistry, Wright State University; Ioana E. Sizemore, Ph.D., associate professor of chemistry, Department of Chemistry, Wright State University; Kent E. Harshbarger, M.D., J.D., coroner, Montgomery County Coroner’s Office/Miami Valley Regional Crime Lab; Heather M. Antonides, technical leader, Montgomery County Coroner’s Office/Miami Valley Regional Crime Lab; and Robert G. Carlson, Ph.D., professor and director of CITAR, Wright State University Boonshoft School of Medicine.
The Wright State University Boonshoft School of Medicine is a community-based medical school affiliated with seven major teaching hospitals in the Dayton area. The medical school educates the next generation of physicians by providing medical education for more than 459 medical students and 458 residents and fellows in 13 specialty areas and 10 subspecialties. Its research enterprise encompasses centers in the basic sciences, epidemiology, public health and community outreach programs. More than 1,500 of the medical school’s 3,328 alumni remain in medical practice in Ohio.