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Illicitly manufactured fentanyls drove overdose deaths across the US in 2020

According to a new study, ilicitly manufactured fentanyls (IMFs) were involved in almost two-thirds of the overdose deaths in the US during 2020, and 40% of those deaths also involved the use of stimulants.

The use of IMFs has grown rapidly in recent years, especially in western states. IMFs were originally introduced as adulterants in white powder heroin; however, they have increasingly been marketed in pill forms resembling oxycodone, alprazolam, and other prescription drugs, often to users unaware of the actual contents of the pill.

To understand more about the involvement of IMFs in overdose deaths, the authors collected data on over 33,000 overdose deaths from 29 states and the District of Columbia between July 2019 and December 2020. Data were drawn from the CDC’s State Unintentional Drug Overdose Reporting System database.

Key findings included:

  • Across regions, 40% to 45% of IMF-related deaths co-involved stimulants, primarily cocaine, while 19%-32% co-involved opioids, primarily heroin, except in the West, where methamphetamine and prescription opioids were more commonly co-involved.
  • Benzodiazepines were coinvolved in 12%-15% of deaths.
  • Between 40% and 50% of IMF-related deaths involved no other opioid or stimulant.
  • While injection was the single most commonly reported administration route, non-injection routes (snorting, smoking, or ingestion) were reported in 57% of deaths in the West and 19%-26% in other regions.
  • Sixty-four percent of deaths occurred in the decedent’s own home, and 56% of decedents had no pulse when first responders arrived.

The implications of these findings include that IMFs “are well established in many drug markets, independent of heroin,” the authors note, and that expansion of education efforts is needed to reduce the risks from counterfeit pills, “as persons might be unaware that they contain IMFs or even opioids.” Outreach to those potentially at risk should also be expanded beyond harm-reduction services such as syringe-services programs, as many of those at risk may not be injecting drugs.

“Urgent action is needed to slow and reverse rapid increases in drug overdose deaths involving IMFs and other drugs,” they conclude, “including enhancing access to substance use disorder treatment…and expanding harm-reduction approaches that address risk factors associated with IMFs (eg, 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).”

O'Donnell J, Tanz LJ, Gladden RM, Davis NL, Bitting J. Trends in and Characteristics of Drug Overdose Deaths Involving Illicitly Manufactured Fentanyls - United States, 2019-2020. MMWR Morb Mortal Wkly Rep. 2021;70(50):1740-1746.