Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance.

BACKGROUND: The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS: The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. RESULTS: Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. CONCLUSIONS: The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Raman spectroscopy as a simple, rapid, nondestructive screening test for methamphetamine in clandestine laboratory liquids.

Raman spectroscopy has found increased use in the forensic controlled substances laboratory in recent years due to its rapid and nondestructive analysis capabilities. Here, Raman spectroscopy as a screening test for methamphetamine in clandestine laboratory liquid samples is discussed as a way to improve the efficiency of a laboratory by identifying the most probative samples for further workup among multiple samples submitted for analysis. Solutions of methamphetamine in ethanol, diethyl ether, and Coleman fuel were prepared in concentrations ranging from 0.5% to 10% w/v, and Raman spectra of each were collected. A concentration-dependent Raman peak was observed at 1003 per cm in each solution in 4% w/v and greater solutions. Case samples were analyzed and also found to reliably contain this diagnostic peak when methamphetamine was present. The use of this diagnostic indicator can save the forensic controlled substances laboratory time and materials when analyzing clandestine laboratory liquid submissions.