Law Enforcement Agencies Report Large Increases in Synthetic Opioid–Involved Overdose Deaths Interview with:

R. Matthew Gladden, PhD Surveillance and Epidemiology Team Division of Unintentional Injury Prevention Centers for Disease Control and Prevention

Dr. R. Mathew Gladden

R. Matthew Gladden, PhD
Surveillance and Epidemiology Team, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention What is the background for this study?

Response: In March and October 2015, the Drug Enforcement Administration (DEA) and CDC, respectively, issued nationwide alerts identifying illicitly manufactured fentanyl (IMF) as a threat to public health and safety.IMF is unlawfully produced fentanyl, obtained through illicit drug markets, includes fentanyl analogs, and is commonly mixed with or sold as heroin. Starting in 2013, the production and distribution of IMF increased to unprecedented levels, fueled by increases in the global supply, processing, and distribution of fentanyl and fentanyl-precursor chemicals by criminal organizations.

Fentanyl is a synthetic opioid 50?100 times more potent than morphine. Multiple states have reported increases in fentanyl-involved overdose (poisoning) deaths (fentanyl deaths). This report examined the number of drug products obtained by law enforcement that tested positive for fentanyl (fentanyl submissions) and synthetic opioid-involved deaths other than methadone (synthetic opioid deaths), which include fentanyl deaths and deaths involving other synthetic opioids (e.g., tramadol). What are the main findings?

Response: During 2013-2014, fentanyl submissions in the United States increased by 426%, from 1,015 in 2013 to 5,343 in 2014, and synthetic opioid deaths increased by 79%, from 3,105 in 2013 to 5,544 in 2014. In the 27 states that consistently report the specific drug(s) contributing to drug overdose deaths, synthetic opioid deaths sharply increased in 8 high-burden states from 2013-2014 (i.e., a 1-year increase in synthetic opioid deaths exceeding two per 100,000 residents, or a 1-year increase of ≥100 synthetic opioid deaths during 2013?2014). Six of the eight high-burden states published data on fentanyl deaths from 2013 and 2014 and analysis of the state data indicates that increases in fentanyl deaths were driving the increases in synthetic opioid deaths in these six states. Given the strong correlation between increases in fentanyl submissions (primarily driven by IMF) and increases in synthetic opioid deaths (primarily fentanyl deaths), and uncorrelated stable fentanyl prescription rates, it is hypothesized that IMF is driving the increases in fentanyl deaths. Among high-burden states, all demographic groups experienced substantial increases in synthetic opioid death rates from 2013-2014. Increases of >200% occurred among males (227%); persons aged 15-24 years (347%), 25-34 years (248%), and 35-44 (230%) years; Hispanics (290%), and persons living in large fringe metro areas (230%).

The highest rates of synthetic opioid deaths in 2014 were among males (5.1 per 100,000); non-Hispanics whites (4.6 per 100,000); and persons aged 25-34 years (8.3 per 100,000), 35?44 years (7.4 per 100,000), and 45?54 years (5.7 per 100,000). The rapid changes in the demographics of synthetic opioid deaths demographics of synthetic opioid deaths are consistent with the changes in demographics of persons using heroin, in particular, increasing use among non-Hispanic white men aged 25-44 years. What should readers take away from your report?

Response: An urgent, collaborative public health and law enforcement response is needed to address the increasing problem of  illicitly manufactured fentanyl and fentanyl deaths. Recently released fentanyl submissions data indicate that 15 states experienced >100 fentanyl submissions in 2015. This is up from 11 states in 2014. This finding coupled with the strong correlation between fentanyl submissions and fentanyl-involved overdose deaths supported by this report likely indicate the problem of IMF is rapidly expanding. The Secretary of Health and Human Services has launched an initiative to reduce opioid misuse, abuse, and overdose by expanding medication-assisted treatment, increasing the availability and use of naloxone, and promoting safer opioid prescribing.

Efforts should focus on:

1) improving timeliness of opioid surveillance to facilitate faster identification and response to spikes in fentanyl overdoses;

2) expanding testing for fentanyl and fentanyl analogs by physicians, treatment programs, and medical examiners/coroners in high-burden states;

3) expanding evidence-based harm reduction and expanding naloxone access, with a focus on persons using heroin;

4) implementing programs that increase linkage and access to medication-assisted treatment, with a focus on persons using heroin;

5) increasing collaboration between public health and public safety; and

6) planning rapid response in high-burden states and states beginning to experience increases in fentanyl submissions or deaths. Is there anything else you would like to add?

Response: If you or someone you know needs assistance, there is help. SAMHSA’s National Helpline is free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental health and/or substance abuse disorder-800.662.HELP (4357). Thank you for your contribution to the community.


Gladden RM, Martinez P, Seth P. Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid–Involved Overdose Deaths — 27 States, 2013–2014. MMWR Morb Mortal Wkly Rep 2016;65:837–843. DOI:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 29, 2016 by Marie Benz MD FAAD