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CDC Describes Burgeoning Overdose Deaths from Fentanyl

MedicalResearch.com Interview with:

Julie O’Donnell, PhD MPH Division of Overdose Prevention National Center for Injury Prevention and Control CDC National Network of Public Health Institutes New Orleans, Louisiana

Dr. O’Donnell

Julie O’Donnell, PhD MPH
Division of Overdose Prevention
National Center for Injury Prevention and Control
National Network of Public Health Institutes
New Orleans, Louisiana

MedicalResearch.com: What is the background for this study?

Response: The estimated number of drug overdose deaths in the US surpassed 100,000 over a 12-month period for the first time during May 2020-April 2021, driven by the involvement of synthetic opioids other than methadone (mainly illicitly manufactured fentanyl (IMF)), according to data from the National Vital Statistics System.

The State Unintentional Drug Overdose Reporting System (SUDORS) is a CDC-funded surveillance program that has collected detailed data on unintentional and undetermined intent drug overdose deaths since 2016 from death certificates, medical examiner and coroner reports, and full postmortem toxicology reports. SUDORS data allow for the analysis specifically of deaths involving fentanyl (rather than the larger category of synthetic opioids), and contain information about decedent demographics and other characteristics, as well as circumstances surrounding the overdose that might help inform prevention.

MedicalResearch.com:? What are the main findings?

Response: Among 29 states and the District of Columbia participating in SUDORS, the proportion of overdose deaths that involved illicitly manufactured fentanyl increased sharply during July 2019-December 2020 in the Midwest (33.1% relative increase), South (64.7% relative increase), and West (93.9% relative increase), while largely remaining stable in the Northeast (3.5% relative increase). Among IMF-involved deaths that occurred during 2020 in 39 states and the District of Columbia, approximately four in 10 deaths also involved a stimulant, and 56.1% of decedents had no pulse when first responders arrived.

Injection drug use was the most frequently reported individual route of drugs use (24.5%), but evidence of snorting, smoking, or ingestion, without evidence of injection, was reported in 27.1% of deaths. Evidence of non-injection routes of drug use were documented more frequently in the West.

MedicalResearch.com: What should readers take away from your report?

Response: This report highlights four main findings regarding IMF-involved deaths:

1) deaths increased sharply in midwestern, southern, and western jurisdictions during 2019–2020;
2) approximately four in 10 deaths also involved stimulants;
3) approximately one half of decedents had no pulse when first responders arrived; and
4) evidence of injection was the most frequently documented route of drug use, but substantial percentages of deaths likely involved other routes, especially in the West.

Urgent action is needed to slow and reverse rapid increases in drug overdose deaths involving illicitly manufactured fentanyl 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). Innovative approaches are needed to address the endemic nature of IMF-involved overdoses, non-injection routes of IMF use, and frequent polysubstance use (in particular, the rising use of opioids and stimulants).

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Among illicitly manufactured fentanyl-involved deaths in Western jurisdictions, 13.3% of deaths had evidence of counterfeit pill use (i.e., pills containing illicitly manufactured fentanyl that are designed to look like prescription oxycodone, alprazolam, or other medications), compared to <1% in other regions. Decedents of IMF-involved overdose deaths in the West were also younger than decedents in other regions (21.8% aged <25 years in the West compared to 5.9-8.7% in other regions). Investigating the higher proportion of illicitly manufactured fentanyl -involved deaths among young persons in the West and whether and how these deaths are linked to counterfeit pills and other routes of use is needed.


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;70:1740-1746. DOI: http://dx.doi.org/10.15585/mmwr.mm7050e3external icon.

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Last Updated on December 28, 2021 by Marie Benz MD FAAD