Improvements in Toxicology Testing to Identify Fentanyl Analogs and Other Novel Synthetic Opioids in Fatal Drug Overdoses, Connecticut, January 2016-June 2019.

OBJECTIVES: Drug overdose deaths in Connecticut increasingly involve a growing number of fentanyl analogs and other novel nonfentanyl synthetic opioids (ie, novel synthetics). Current postmortem toxicology testing methods often lack the sophistication needed to detect these compounds. We examined how improved toxicology testing of fatal drug overdoses can determine the prevalence and rapidly evolving trends of novel synthetics. METHODS: From 2016 to June 2019, the Connecticut Office of the Chief Medical Examiner increased its scope of toxicology testing of suspected drug overdose deaths in Connecticut from basic to enhanced toxicology testing to detect novel synthetics. The toxicology laboratory also expanded its testing panels during this time. We analyzed toxicology results to identify and quantify the involvement of novel synthetics over time. RESULTS: From 2016 to June 2019, 3204 drug overdose deaths received enhanced toxicology testing; novel synthetics were detected in 174 (5.4%) instances. Ten different novel synthetics were detected with 205 total occurrences. Of 174 overdose deaths with a novel synthetic detected, most had 1 (n = 146, 83.9%) or 2 (n = 26, 14.9%) novel synthetics detected, with a maximum of 4 novel synthetics detected. Para-fluorobutyrylfentanyl/FIBF, furanylfentanyl, and U-47700 were most identified overall, but specific novel synthetics came in and out of prominence during the study period, and the variety of novel synthetics detected changed from year to year. CONCLUSIONS: Enhanced toxicology testing for drug overdose deaths is effective in detecting novel synthetics that are not identified through basic toxicology testing. Identifying emerging novel synthetics allows for a timely and focused response to potential drug outbreaks and illustrates the changing drug market.

Evaluating opioid overdose using the National Violent Death Reporting System, 2016.

BACKGROUND: Unintentional opioid overdose death rates have increased nearly 500% in Connecticut from 1999 to 2016, resulting in a major public health crisis. Two primary types of opioids have been implicated in these fatalities - illicit and pharmaceutical. The objective of this study is to describe the epidemiology of fatal unintentional opioid overdoses by type. METHODS: Using the National Violent Death Reporting System, rates of unintentional opioid-related overdose death in Connecticut were calculated. Demographic and contextual characteristics (e.g., substance misuse, mental health issues), and concomitant drug use (e.g., benzodiazepines, cocaine) were compared by opioid type. RESULTS: In 2016, 867 victims of fatal unintentional opioid overdose were identified in Connecticut. The majority of deaths involved illicit opioids (79.6%). Overall, victims were mostly male, white, non-Hispanic, and aged 25-54 years. Victim sex, age, and contextual characteristics differed significantly according to opioid type. For illicit opioid deaths, victims were predominantly male, aged 44 and under, and more often had a history of substance misuse. In contrast, among pharmaceutical opioid deaths, the split between males and females was significantly less pronounced, victims were mostly aged 45 and over, and mental health diagnoses, a physical health problem and concomitant drug use were more prevalent. CONCLUSIONS: Based on our findings, efforts to curb opioid-related overdose should be specific to opioid type. Interventions pertaining to pharmaceutical opioids should target females and older adults, whereas interventions for illicit opioid use should target younger audiences.