Association of Law Enforcement Seizures of Heroin, Fentanyl, and Carfentanil With Opioid Overdose Deaths in Ohio, 2014-2017.
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SUBMITTER: Zibbell JE
PROVIDER: S-EPMC6902770 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundUnited States drug overdose deaths are being driven by the increasing prevalence of fentanyl, but whether patients are knowingly using fentanyl is unclear. We examined the analytical confirmation of fentanyl in emergency department (ED) patients with documented heroin overdose.HypothesisWe hypothesized that the proportion of fentanyl and fentanyl analogs would be higher than that of confirmed heroin.MethodsThis is a subgroup analysis from a prospective multicenter consecutive cohort of ED patients age 18+ with opioid overdose presenting to 10 US sites within the Toxicology Investigators Consortium from 2020 to 2021. Toxicology analysis was performed using liquid chromatography quadrupole time-of-flight mass spectrometry. De-identified toxicology results were paired with the clinical database. The primary outcome was the proportion of patients with fentanyl analytes detected in their serum.ResultsOf 1006 patients screened, 406 were eligible, and of 168 patients who reported that they had taken heroin or had a documented heroin overdose, 88% (n = 147) were in fact found to have fentanyl and/or a fentanyl analog present on serum analysis (p < 0.0001). In contrast, only 46 of the 168 patients with reported or documented heroin overdose (27%) were found to have heroin biomarkers present.ConclusionThe prevalence of confirmed fentanyl in ED patients with suspected heroin overdose was extremely high, while the prevalence of heroin was very low. There was a high degree of mismatch between the opioids believed to be the overdose agent versus the actual opioids identified on serum toxicology. Clinicians in the United States should presume that fentanyl is involved in all illicit opioid overdoses and should counsel patients on harm reduction measures.
| S-EPMC11331419 | biostudies-literature
Project description:BackgroundThe overdose epidemic in the United States (US) continues to generate unprecedented levels of mortality. There is urgent need for a national data system capable of yielding high-quality, timely, and actionable information on existing and emerging drugs. Public health researchers have started using law enforcement forensic laboratory data to obtain surveillance information on illicit drugs. This study is the first to use drug reports from the entire US to examine correlations between a changing drug supply and increasing opioid-involved overdose deaths (OOD) on a national scale.MethodsThis study is observational and investigates associations between law enforcement drug reports and OOD for the US from 2014 to 2019. OOD data are from the Centers for Disease Control and Prevention's National Vital Statistics System restricted-use multiple cause of death files. The US Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) contains forensic laboratory-tested drug exhibit information for the entire US (NFLIS-Drug). Counts of forensic laboratory reports and OOD were aggregated for each state by month, quarter, and year. A difference-in-differences framework was used to estimate contemporaneous and lagged associations.FindingsBetween 2014 and 2019 in the US, 249,522 OOD were reported, with the annual number nearly doubling from 28,723 to 50,179. OOD involving illicitly manufactured fentanyls (IMF) also increased substantially during this period, from 19.4% to 72.9%. In addition, 3,817,438 forensic laboratory reports in the US that were reported to NFLIS-Drug contained an opioid, stimulant, or benzodiazepine. Reports of fentanyl and fentanyl-related compounds (FFRC) had the strongest association with OOD. Each additional FFRC exhibit was associated with a 2.97% (95% CI: 1.7%, 4.1%) increase in OOD per 100,000 persons per quarter.InterpretationAdding to the emerging consensus, protracted growth in IMF supply was more strongly associated with OOD than all other illicit drugs reported to NFLIS-Drug over the study time period. Findings demonstrate NFLIS-Drug data usefulness for research that require proxy indicators for the illicit drugs supply. A concerted effort between public health and public safety to make NFLIS-Drug more timely could strengthen its utility as a national, public health, drug surveillance system.FundingSangeetha Arctic Slope Mission Services, LLC, ASMS Contract No. ASM5-00017.
| S-EPMC10423896 | biostudies-literature
Project description:ObjectiveTo compare user self-identification of nonpharmaceutical fentanyl exposure with confirmatory urine drug testing in emergency department (ED) patients presenting after heroin overdose.MethodsThis was a cross-sectional study of adult ED patients who presented after a heroin overdose requiring naloxone administration. Participants provided verbal consent after which they were asked a series of questions regarding their knowledge, attitudes and beliefs toward heroin and nonpharmaceutical fentanyl. Participants also provided urine samples, which were analyzed using liquid chromatography coupled to quadrupole time-of-flight mass spectrometry to identify the presence of fentanyl, heroin metabolites, other clandestine opioids, common pharmaceuticals and drugs of abuse.ResultsThirty participants were enrolled in the study period. Ten participants (33%) had never required naloxone for an overdose in the past, 20 participants (67%) reported recent abstinence, and 12 participants (40%) reported concomitant cocaine use. Naloxone was detected in all urine drug screens. Heroin or its metabolites were detected in almost all samples (93.3%), as were fentanyl (96.7%) and its metabolite, norfentanyl (93.3%). Acetylfentanyl was identified in nine samples (30%) while U-47700 was present in two samples (6.7%). Sixteen participants self-identified fentanyl in their heroin (sensitivity 55%); participants were inconsistent in their qualitative ability to identify fentanyl in heroin.ConclusionsHeroin users presenting to the ED after heroin overdose requiring naloxone are unable to accurately identify the presence of nonpharmaceutical fentanyl in heroin. Additionally, cutting edge drug testing methodologies identified fentanyl exposures in 96.7% of our patients, as well as unexpected clandestine opioids (like acetylfentanyl and U-47700).
| S-EPMC5975225 | biostudies-literature
Project description:Background and aimsIt is widely believed that the 2018 decline in overdose deaths in the United States was attributable to a range of public health interventions, however, this decline also coincided with the regulation and decline in use of potent fentanyl analogs, especially carfentanil. The aim of this study was to investigate the association between overdose deaths and carfentanil availability in the United States.DesignSecondary analysis of drug overdose deaths from the Center for Disease Control and Prevention (CDC) and carfentanil exhibit data from drug seizures submitted to drug crime labs and published by the Drug Enforcement Administration (DEA). Trends in overdose deaths were compared in states with high carfentanil exhibits with states with low or no carfentanil exhibits.SettingUnited States.ParticipantsA total of 1 035 923 drug overdose death records in the United States from 1979 through 2019 were studied.MeasurementsThe outcomes studied were number of overdose deaths and mortality rates by state.FindingsDrug overdose deaths have been closely tracked along an exponential curve. The years 2016 and 2017 witnessed a hyper-exponential surge with increases in overdose deaths of 11 228 (+21.4%) and 6605 (+10.4%), respectively. Subsequently in 2018, drug overdose deaths declined by -2870 (-4.1%). This rise and then fall coincided with a surge and then decline in carfentanil drug seizure exhibits during these same years: 0 (2015), 1292 (2016), 5857 (2017) and 804 (2018). The majority of carfentanil exhibits were localized to a few states. The 2018 decline in overdose deaths in the top five states with the greatest spike in carfentanil exhibits in 2017 (Ohio, Florida, Pennsylvania, Kentucky and Michigan) was 2848, which accounted for nearly all of the total US decline.ConclusionsThe 2016-2017 acceleration and then 2018 decline in drug overdose deaths in the United States was associated with the sudden rise and then fall of carfentanil availability. Given the regional variation, carfentanil's decreased availability may have contributed to the reduction in overdose deaths in 2018.
| S-EPMC8019064 | biostudies-literature
Project description:BackgroundDrug overdose mortality continues to increase, now driven by fentanyl. Prevention tools such as naloxone and medications to treat opioid use disorder are not sufficient to control overdose rates; additional strategies are urgently needed.ObjectiveWe sought to adapt a behavioral intervention to prevent opioid overdose (repeated-dose behavioral intervention to reduce opioid overdose [REBOOT]) that had been successfully piloted in San Francisco, California, United States, to the setting of Boston, Massachusetts, United States, and the era of fentanyl for a full efficacy trial.MethodsWe used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework for intervention adaptation. We first identified opioid overdose survivors who were actively using opioids as the population of interest and REBOOT as the intervention to be adapted. We then performed theater testing and elicited feedback with 2 focus groups (n=10) in Boston in 2018. All participants had used opioids that were not prescribed to them in the past year and experienced an opioid overdose during their lifetime. We incorporated focus group findings into our initial draft of the adapted REBOOT intervention. The adapted intervention was reviewed by 3 topical experts, and their feedback was integrated into a subsequent draft. We trained study staff on the intervention and made final refinements based on internal piloting. This paper describes the overall ADAPT-ITT process for intervention adaptation, as well as a qualitative analysis of the focus groups. Working independently, 2 authors (VMM and JA) reviewed the focus group transcripts and coded them for salient and common themes using the constant comparison method, meeting to discuss any discrepancies until consensus was reached. Codes and themes were then mapped onto the REBOOT counseling steps.ResultsFocus group findings contributed to substantial changes in the counseling intervention to better address fentanyl overdose risk. Participants described the widespread prevalence of fentanyl and said that, although they tried to avoid it, avoidance was becoming impossible. Using alone and lower opioid tolerance were identified as contributors to overdose risk. Slow shots or tester shots were acceptable and considered effective to reduce risk. Naloxone was considered an effective reversal strategy. Although calling emergency services was not ruled out, participants described techniques to prevent the arrival of police on the scene. Expert review and internal piloting improved the intervention manual through increased participant centeredness, clarity, and usability.ConclusionsWe successfully completed the ADAPT-ITT approach for an overdose prevention intervention, using theater testing with people who use opioids to incorporate the perspectives of people who use drugs into a substance use intervention. In the current crisis, overdose prevention strategies must be adapted to the context of fentanyl, and innovative strategies must be deployed, including behavioral interventions.Trial registrationClinicalTrials.gov NCT03838510; https://clinicaltrials.gov/ct2/show/NCT03838510.
| S-EPMC9494212 | biostudies-literature
Project description:BackgroundDrug overdose is one of the top leading causes of accidental death in the U.S., largely due to the opioid epidemic. Although the opioid epidemic is a nationwide issue, it has not affected the nation uniformly.MethodsWe combined multiple data sources, including emergency medical service response, American Community Survey data, and health facilities datasets to analyze distributions of heroin-related overdose incidents in Cincinnati, Ohio at the census block group level. The Ripley's K function and the local Moran's I statistics were performed to examine geographic variation patterns in heroin-related overdose incidents within the study area. Then, conditional cluster maps were plotted to examine a relationship between heroin-related incident rates and sociodemographic characteristics of areas as well as the resources for opioid use disorder treatment.ResultsThe global spatial analysis indicated that there was a clustered pattern of heroin-related overdose incident rates at every distance across the study area. The univariate local spatial analysis identified 7 hot spot clusters, 27 cold spot clusters, and 1 outlier cluster. Conditional cluster maps showed characteristics of neighborhoods with high heroin overdose rates, such as a higher crime rate, a high percentage of the male, a high poverty level, a lower education level, and a lower income level. The hot spots in the Southwest areas of Cincinnati had longer distances to opioid treatment programs and buprenorphine prescribing physicians than the median, while the hot spots in the South-Central areas of the city had shorter distances to those health resources.ConclusionsOur study showed that the opioid epidemic disproportionately affected Cincinnati. Multi-phased spatial clustering models based on various data sources can be useful to identify areas that require more policy attention and targeted interventions to alleviate high heroin-related overdose rates.
| S-EPMC9233379 | biostudies-literature
Project description:BACKGROUND:Fentanyl-adulterated heroin supply chains are increasing risks for fatal overdose in the U.S. OBJECTIVE:The current study examined the use of overdose risk reduction behaviors among persons seeking treatment for heroin use and whether perceptions about the presence of fentanyl in one's heroin are associated with overdose risk reduction behaviors. METHOD:We recruited persons with opioid use disorder entering a managed withdrawal program. We used multiple linear regression to estimate the adjusted associations of participant characteristics and perception of fentanyl exposure with the frequency of engaging in each of five overdose reduction behaviors. RESULTS:Participants (n?=?239; 75.3% male, 81.2% White, 67% injectors) estimated that 69.2% of the heroin they use contains fentanyl, and 94.6% knew that fentanyl increases overdose risk. Approximately 30% of respondents reported usually or always making sure others are around when they use heroin, carrying naloxone, taking "tester" doses of heroin or intentionally using in reduced amounts. While a majority of the sample reported never carrying naloxone or taking tester doses, and 70.2% reported never making sure that others around them carry naloxone, 84.5% had implemented one or more behavior at least rarely. Past month injection drug use was associated with making sure others are around, but perceptions about fentanyl in one's heroin were not associated with use of harm reduction behaviors. CONCLUSIONS:In this sample of people who use heroin, although overdose risk reduction behaviors were not usually used, a majority had tried at least one behavior. That perceived exposure to fentanyl-adulterated heroin was not associated with the use of such behaviors provides important implications for public health education and intervention programming.
| S-EPMC6702957 | biostudies-literature
Project description:Ohio is one of the states most impacted by the opioid epidemic and experienced the second highest age-adjusted fatal drug overdose rate in 2017. Initially it was believed prescription opioids were driving the opioid crisis in Ohio. However, as the epidemic evolved, opioid overdose deaths due to fentanyl have drastically increased. In this work we develop a Bayesian multivariate spatiotemporal model for Ohio county overdose death rates from 2007 to 2018 due to different types of opioids. The log-odds are assumed to follow a spatially varying change point regression model. By assuming the regression coefficients are a multivariate conditional autoregressive process, we capture spatial dependence within each drug type and also dependence across drug types. The proposed model allows us to not only study spatiotemporal trends in overdose death rates but also to detect county-level shifts in these trends over time for various types of opioids.
| S-EPMC8553088 | biostudies-literature
Project description:Objectives. To contrast the geographic distribution of fentanyl-involved and non-fentanyl-involved fatal overdoses between 2014 and 2018 in Cook County, Illinois.Methods. We conducted a spatial analysis using locations of fentanyl-involved fatal overdoses (n?=?1433) compared with nonfentanyl opioid and polydrug fatal overdoses (n?=?1838) collected through the Cook County Medical Examiner's Office from 2014 to 2018. We also used logistic regression to test significant individual- and neighborhood-level covariates.Results. Fentanyl overdoses geographically clustered more than nonfentanyl overdoses, and this difference was statistically significant. One area in particular showed significantly elevated risk for fentanyl overdoses (P?<?.05) located in 2 specific neighborhoods of Chicago. The odds of a fentanyl-involved overdose were significantly increased for men, Blacks, Latinos/as, and younger individuals. Neighborhood deprivation score was the only significant neighborhood-level predictor (odds ratio?=?1.11; 95% confidence interval?=?1.07, 1.17).Conclusions. Fentanyl-involved fatal overdoses follow a distinct geographic distribution associated with resource deprivation in neighborhoods where they occur. This suggests an evolving bifurcated drug market, with drug markets in resource-deprived neighborhoods disproportionately likely to include fentanyl.
| S-EPMC6893352 | biostudies-literature
Project description:BackgroundRates of fatal overdose (OD) from synthetic opioids rose nearly 60 % from 2016 to 2018. 911 Good Samaritan Laws (GSLs) are an evidenced-based strategy for preventing OD fatality. This study describes patrol officers' knowledge of their state's GSL, experience with OD response, and their perspectives on strategies to prevent and respond to opioid OD.MethodsAn electronic survey assessed officers' knowledge of state GSLs and experiences responding to OD. Descriptive statistics and hierarchical linear modeling were generated to examine differences in knowledge, preparedness, and endorsement of OD response efforts by experience with OD response.Results2,829 officers responded to the survey. Among those who had responded to an OD call in the past six months (n = 1,946), 37 % reported administering naloxone on scene and 36 % reported making an arrest. Most (91 %) correctly reported whether their state had a GSL in effect. Only 26 % correctly reported whether that law provides limited immunity from arrest. Fifteen percent of officers who had responded to an OD work in departments that do not carry naloxone. Compared with officers who had not responded to any OD calls, those who reported responding OD calls at least monthly and at least weekly, were significantly less likely to endorse OD response efforts.ConclusionOfficers who respond to OD calls are generally receiving training and naloxone supplies to respond, but knowledge gaps and additional training needs persist. Additional training and strategies to relieve compassion fatigue among those who have more experience with OD response efforts may be indicated.
| S-EPMC7475730 | biostudies-literature