Fentanyl plays rising role in Ohio overdose deaths

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Heroin’s role in overdose deaths appears to be on the decline while other powerful opioids like fentanyl are on the rise as the culprit in Ohio overdose deaths.

More than 90 percent of unintentional overdose deaths in 24 Ohio counties in January and February involved fentanyl and drugs with a molecular structure similar to fentanyl, also called fentanyl analogs, while heroin was identified in only about 6 percent of cases, according to a new study by researchers with the Wright State University Boonshoft School of Medicine.

In Ohio, unintentional drug overdoses are the leading cause of accidental death. The Montgomery County coroner reported 385 deaths as the unofficial count as of mid June, with the overdose rate sharply up from 349 in 2016.

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“There are much more resources and much more being done to help people but the drugs that people are exposed to are so much more potent. All these resources, they can’t counteract it completely,’ said Raminta Daniulaityte, associate director of the Boonshoft’s Center for Interventions, Treatment, and Addictions Research.

The effects of these drugs are more unpredictable and dangerous. Pharmaceutical fentanyl is similar to morphine but 50 to 100 times more powerful, while illicitly manufactured fentanyl may have an even greater effect and often requires multiple naloxone doses to reverse overdoses.

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Evidence from the WSU study indicates the increasing and substantial role of illicitly manufactured fentanyl and the declining presence of heroin and pharmaceutical opioids in overdose fatalities. The study also found that fentanyl is commonly appearing in combination with other analogs.

The deceased were mostly men and more than half of the deaths were people between ages 25 and 44.

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The study identified fentanyl and fentanyl analogs and other drugs in 281 unintentional overdose fatalities. Boonshoft researchers worked with the Montgomery County Coroner’s Office and Miami Valley Regional Crime Lab on the work funded by a grant from the National Institutes of Health and National Institute on Drug Abuse.

In the study:

  • Men accounted for 181 of the unintentional overdose deaths.
  • More than half of the deaths occurred in people ages 25 through 44.
  • Only 6 percent tested positive for heroin. The percentage of heroin positive cases was greater in Appalachian counties.
  • Among the 16 heroin-positive cases, 12 also tested positive for illicitly manufactured fentanyl.
  • Twenty-one people who died, including 11 in Montgomery County, tested positive for carfentanil, a highly toxic IMF compound, which is about 10,000 times more potent than morphine and used in veterinary medicine for large animals.

Illicitly manufactured fentanyl and its analogs have not been part of routine toxicology testing so there’s been little data on the current outbreak.

Daniulaityte said when her team started its research, the lab didn’t have the testing to find different types of fentanyl analogs, so they had to develop the testing and didn’t know what to expect to find.

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As part of the ongoing project, researchers will be talking with people who are using drugs and also to now test overdose cases for 2015 and 2016 to see what kind of drugs were contributors.


What is fentanyl?

Pharmaceutical fentanyl is a powerful synthetic opioid pain reliever that’s similar to morphine, but it is 50 to 100 times more powerful and is used to treat patients with severe pain. Illicitly manufactured fentanyl may have a greater potency than pharmaceutical fentanyl and often requires multiple naloxone doses to reverse overdoses.

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