During a 15-year period from 1990 to 2004, the North Carolina Office of the Chief Medical Examiner (NC-OCME) investigated almost 200 deaths in
which the cause of death included fentanyl toxicity. During this time the annual cases of fentanyl toxicity increased from none in 1990 to 53 in 2004. The total annual cases investigated by NC-OCME during this period ranged from 7806 to 8827 (1). In the last five years alone, the number of fentanyl-related deaths increased by more than 300%.