Illicitly manufactured fentanyls involved in increasing number of U.S. overdose deaths

Synthetic opioids, including illicitly manufactured fentanyls (IMFs), are involved in a growing number of drug overdose deaths in the U.S., with sharp increases seen in several regions during 2019-2020, according to federal data.

Researchers used data from the CDC's State Unintentional Drug Overdose Reporting System (SUDORS) to describe trends in overdose deaths involving IMFs during July 2019 to December 2020 in 29 states and the District of Columbia, as well as characteristics of IMF-involved deaths during 2020 in 39 states and the District of Columbia. The results were published early online Dec. 14 by MMWR.

From July 2019 to December 2020, sharp increases were seen in IMF-involved deaths in midwestern (33.1%), southern (64.7%), and western (93.9%) jurisdictions that participated in SUDORS. In addition, about 40% of IMF-involved deaths also involved a stimulant. Cocaine and heroin were the most commonly co-involved stimulant and opioid, respectively, in all regions besides the West, where methamphetamine and prescription opioids were most common. Many IMF-involved deaths involved no other opioid or stimulant: 39.7% in the Northeast, 40.6% in the Midwest, 31.7% in the South, and 49.5% in the West.

Seventy-three percent of IMF-involved deaths occurred in men, and overall, 56.1% of those who died had no pulse when first responders arrived. Most people (64.2%) died at their own home or in a house or apartment that belonged to someone else (14.8%); 34.7% of deaths occurred with someone else present who did not respond, usually due to lack of immediate proximity. Injection drug use was the most common route of use (24.5%), but 27.1% of those who died appeared to have snorted, smoked, or ingested the drug instead.

The researchers noted that their findings are not nationally representative, that regions can differ in investigations of deaths, and that it can be difficult to gather data on some characteristics, such as drug use route. “Urgent action is needed to slow and reverse rapid increases in drug overdose deaths involving IMFs and other drugs, including enhancing access to substance use disorder treatment (e.g., medications for opioid use disorder) and expanding harm reduction approaches that address risk factors associated with IMFs (e.g., improving and expanding distribution of naloxone to persons who use drugs and their friends and family, distributing fentanyl test strips to test drug products for fentanyl, and increasing overdose education and access to comprehensive syringe services programs),” they wrote. “Innovative approaches are needed to address the endemic nature of IMF-involved overdoses, noninjection routes of IMF use, and frequent polysubstance use, in particular, the rising use of opioids and stimulants.”