Analyzing Street Drugs Can Provide Early Warning of Potential For Fatal Overdoses Interview with:
“MEXICO-DRUGS/” by Claudio Toledo is licensed under CC BY 2.0Kathleen Creppage, M.P.H., C.P.H.
Doctoral candidate Graduate School of Public Health
University of Pittsburgh What is the background for this study? What are the main findings?

Response: In the U.S., fatal heroin overdoses have increased in the past decade by 300 percent, with fentanyl – a substance that is 20 to 50 times more potent than heroin – and its analogs increasingly contributing to overdoses. The drug often is implicated in clusters of overdose deaths when it is mixed with heroin and users do not realize what they are taking is more powerful than usual.

We analyzed the test results of 16,594 stamp bags seized as evidence by law enforcement authorities in Allegheny County that were submitted to the county’s Office of the Medical Examiner for laboratory testing from 2010 through 2016. Stamp bags are small wax packets that contain mixtures of illicit drugs, most commonly heroin, packaged for sale and sometimes stamped with a graphical logo by drug dealers to market their contents.

Before 2014, none of the tested bags contained fentanyl. By 2016 it was found in 15.5 percent of the tested stamp bags, with 4.1 percent containing fentanyl as the only controlled substance present. What should readers take away from your report?

Response: Our findings suggest that real-time information about stamp bags can be used to supplement current public health surveillance measures and could serve as an early warning of new illegal drugs of high lethality available at the local level.

Toxicology results from overdose victims take weeks or months, and state and national mortality data lag by about 18 months. Drug evidence testing is usually available much more quickly – in Allegheny County it is available for the current month.

Near-real-time analyses like ours — the first robust and detailed public health report of a stamp bag surveillance system — could be used to inform educational campaigns, allocate limited resources and devise prevention strategies. First responders also could benefit from knowing what drugs are in circulation so they can take proper precautions to protect themselves and be prepared with overdose reversal medications, such as naloxone. What recommendations do you have for future research as a result of this work?

Response: Stamp bag testing and monitoring should not replace other drug surveillance systems, such as overdose mortality data and toxicology reports. But it can be a powerful complement to these surveillance systems. The data are available, and we need to identify and explore these different data sources as part of our efforts in understanding and combatting the opioid epidemic. Is there anything else you would like to add?

Response: Additional authors on this study are Karl E. Williams, M.D., M.P.H., Allegheny County Medical Examiner, Anthony Fabio, Ph.D., M.P.H., Jeanine Buchanich, Ph.D., M.Ed., Thomas Songer, Ph.D., and Stephen Wisniewski, Ph.D., all of Pitt Public Health; as well as Joshua Yohannan, drug chemistry laboratory manager at the Allegheny County Office of the Medical Examiner.


Kathleen E. Creppage, Joshua Yohannan, Karl Williams, Jeanine M. Buchanich, Thomas J. Songer, Stephen R. Wisniewski, Anthony Fabio. The Rapid Escalation of Fentanyl in Illicit Drug Evidence in Allegheny County, Pennsylvania, 2010-2016. Public Health Reports, 2018; DOI: 10.1177/0033354917753119 

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Last Updated on February 5, 2018 by Marie Benz MD FAAD