Surge in Fentanyl Deaths in Florida and Ohio Linked to Illicitly Manufactured Opioids Interview with:

Alexis B. Peterson, PhD

Alexis B. Peterson, PhD

Alexis B. Peterson, PhD
(Epidemic Intelligence Service Officer)

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 (Behavioral Scientist) What is the background for this study?

Response: In March and October 2015, the Drug Enforcement Administration and the Centers for Disease Control and Prevention (CDC) issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl, as a threat to public health and safety. During 2013-2014, Ohio and Florida reported significant increases in fentanyl-involved overdose deaths (fentanyl deaths) and fentanyl submissions (drug products obtained by law enforcement that tested positive for fentanyl).

Fentanyl is a synthetic opioid 50-100 times more potent than morphine. The University of Florida and the Ohio Department of Public Health with CDC assistance compared trends in fentanyl deaths, fentanyl submissions, and fentanyl prescribing during January 2013–June 2015.

In-depth review of medical examiner and coroner reports of fentanyl deaths occurring in Ohio’s 14 high-burden counties were performed to identify circumstances surrounding fentanyl overdose death. What are the main findings?

Response: Findings suggest that the surge in fentanyl deaths in Florida and Ohio during 2013–2015 were closely related to increases in the illicitly manufactured fentanyl supply, as opposed to diverted pharmaceutical fentanyl. Increases in fentanyl deaths in both Florida and Ohio paralleled law enforcement fentanyl submissions. During 2013–2014, fentanyl submissions increased 494% in Florida (from 33 to 196) and 1,043% in Ohio (from 109 to 1,246), concurrent with a 115% increase in fentanyl deaths in Florida (from 185 to 397) and a 526% increase in Ohio (from 84 to 526).

The highest fentanyl death rates in Florida during 2013–2014 occurred among persons aged 26–34 years (3.2 per 100,000) and 35–50 years (2.9), males (2.5), and whites (2.1).

Similarly, the highest fentanyl death rates in Ohio’s 14 high-burden counties occurred among persons aged 25–34 years (10.5 per 100,000) and 35–44 years (9.2), males (5.6), and whites (4.2).

Second, circumstances associated with fentanyl deaths in Ohio included a current diagnosed mental health disorder (25%) and recent release from an institution (10%) such as a jail, rehabilitation facility, or hospital in Ohio.

Third, acetyl fentanyl and beta-hydroxythiofentanyl, both illicitly produced fentanyl analogs, were implicated in a significant number of fentanyl deaths in Florida. What should readers take away from your report?

Response: The relationship between fentanyl deaths and fentanyl submissions in both Florida and Ohio suggests that fentanyl submissions data could act as an early warning system to identify changes in the illicit drug supply. The rapid increase in fentanyl deaths in Florida and Ohio illustrates the high potency of fentanyl, with the possibility of rapid death, highlighting the importance of quickly recognizing an overdose, calling 9-1-1 promptly, facilitating rapid administration of 1 or more naloxone doses, and expanding naloxone availability to laypersons and emergency medical services.

Finally, linkage and access to treatment and to naloxone are needed for persons at high risk. What recommendations do you have for future research as a result of this study?

Response: Distinguishing whether an overdose involves illicitly manufactured fentanyl or pharmaceutical fentanyl is critical for targeted interventions because overdose risk profiles differ. Additional work is needed to determine the extent to which medical examiners and coroners can use decedents’ substance use history, scene evidence (e.g., white powder consistent with illicitly manufactured fentanyl or patches consistent with pharmaceutical fentanyl), toxicology (e.g., presence of heroin or cocaine), and prescription drug monitoring program data to distinguish illicitly manufactured from pharmaceutical fentanyl overdoses. Is there anything else you would like to add?

Response: If you or someone you know needs assistance, there is help. SAMHSA’s National Helpine 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.


Peterson AB, Gladden RM, Delcher C, et al. Increases in Fentanyl-Related Overdose Deaths — Florida and Ohio, 2013–2015. MMWR Morb Mortal Wkly Rep 2016;65:844–849. DOI:

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

More Medical Research Interviews on

[wysija_form id=”5″]

Last Updated on August 30, 2016 by Marie Benz MD FAAD