Potent synthetic opioids such as fentanyl have already accelerated the number of deaths from drug overdose in the U.S. in recent years. And now, even stronger versions may make the opioid crisis in the U.S. even worse, according to new data from the Centers for Disease Control and Prevention.
Deaths from drug overdose in this country exceeded 60,000 last year, partially driven by a fivefold increase in deaths involving synthetic opioids such as fentanyl, according to data released Friday. And analogs of fentanyl, such as carfentanil — used to tranquilize large animals — were increasingly implicated in overdose deaths, particularly in Eastern states, according to the CDC's Morbidity and Mortality Weekly Report.
Often the substances were found along with illicit drugs such as heroin and cocaine, raising a concern that these more potent drugs "have become a part of illicit opioid markets in multiple states," the authors wrote.
"Because of its extreme potency, even limited circulation of carfentanil could markedly increase the number of fatal overdoses," they said.
Already the numbers are staggering, driven since 2013 by the introduction of fentanyl into the market for heroin, the CDC said. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine; carfentanil is estimated to be 10,000 times more potent than morphine. Other fentanyl analogs are thought to be less potent. The variability can lead to disaster.
"The increased mixing or co-use of fentanyl, heroin, cocaine, and varying fentanyl analogs might contribute to increased risk for overdose because persons misusing opioids and other drugs are exposed to drug products with substantially varied potency," the report authors wrote.
The data show that the number of overdose deaths involving synthetic opioids rose to 20,000 last year, from 3,105 in 2013.
The report examined data from 10 states, using information from death certificates and coroner reports, in addition to information from death scene investigations and results of forensic toxicology testing. The CDC said this is the first report to use "toxicologic and scene evidence from multiple states to characterize opioid overdose deaths." There were about 700 deaths in which fentanyl analogs were involved.
"This finding raises concern that in the near future, fentanyl analog overdose deaths might mirror the rapidly rising trajectory of fentanyl overdose deaths that began in 2013 and become a major factor in opioid overdose deaths," the authors wrote.
They say the CDC has expanded the number of states participating in its Enhanced State Opioid Overdose Surveillance program to 32 and Washington, D.C., from the 10 included in this report, and increased funding to improve forensic toxicologic testing.
The authors also said measures should be taken to address the growing number of opioid overdose deaths involving fentanyl and fentanyl analogs, including increasing access to medication-assisted treatment — a move also endorsed this week by Food and Drug Administration Commissioner Scott Gottlieb — and increasing availability of the overdose-reversal drug naloxone.