Top 5 Takeaways

1. Sharp Increase in Deaths: IMF-involved overdose deaths surged in midwestern (33.1%), southern (64.7%), and western (93.9%) regions during 2019-2020.
2. Polysubstance Use: Approximately 40% of IMF-involved deaths also involved stimulants, highlighting the complexity of substance use patterns.
3. Immediate Fatality Risk: Over half (56%) of the decedents had no pulse when first responders arrived, indicating the high potency and rapid lethality of IMFs.
4. Routes of Drug Use: Injection was the most common route (25%), but noninjection routes (snorting, smoking, ingestion) were significant, especially in the West (27%).
5. Public Health Recommendations: Enhanced overdose prevention, harm reduction, and innovative approaches are urgently needed to address the risks associated with IMFs and polysubstance use.

Original Article Author and Citation

Corresponding Author

Julie O’Donnell, irh8@cdc.gov

Suggested Citation

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.mm7050e3

Summary

The article reports a significant increase in drug overdose deaths involving illicitly manufactured fentanyls (IMFs) in the United States from 2019 to 2020. The data indicates that these deaths have risen sharply in the Midwest, South, and West. A notable proportion of these deaths also involved stimulants, and many decedents were found without a pulse when first responders arrived. The report emphasizes the need for enhanced overdose prevention and harm reduction strategies to combat the rising fatalities associated with IMFs.

Methods

The study utilized data from the CDC’s State Unintentional Drug Overdose Reporting System (SUDORS), which includes death certificate data, postmortem toxicology results, and death scene findings. The analysis covered 29 states and the District of Columbia for trends from July 2019 to December 2020, and 39 states and DC for characteristics of IMF-involved deaths in 2020. Statistical significance was assessed using z-tests with a p-value threshold of <0.05.

Discussion

The findings highlight the rapid increase in IMF-involved deaths, particularly during the COVID-19 pandemic. The report underscores the complexity of substance use patterns, with significant co-involvement of stimulants and other non-opioid substances. The high potency of IMFs and the rapid onset of overdose symptoms pose significant challenges for timely intervention and survival. The report calls for expanded harm reduction efforts, including improved naloxone distribution and education on overdose recognition and response.

Conclusion

Urgent action is needed to address the rising trend of IMF-involved overdose deaths. This includes enhancing access to substance use disorder treatments, expanding harm reduction strategies, and employing innovative approaches to tackle the multifaceted nature of IMF use and polysubstance involvement. Public health efforts must adapt to the evolving drug landscape to mitigate the increasing fatalities.

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