Characteristics of fentanyl overdose - Massachusetts, 2014-2016

Abstract

What is already known about this topic?Fentanyl has a growing presence in the illicit drug market and is involved in an increasing proportion of opioid overdose deaths.What is added by this report?Approximately two thirds of investigated opioid overdose deaths in southeastern Massachusetts during October 1, 2014-March 31, 2015 involved fentanyl, a majority of which was suspected illicitly manufactured fentanyl (IMF), reported to be widely available in the illicit drug market. Fentanyl overdose can progress rapidly, and a majority of decedents were physically separated from bystanders. Naloxone can reverse fentanyl overdose if administered in sufficient dosage immediately upon recognition of overdose symptoms.What are the implications for public health practice?A comprehensive public health response is needed to address overdoses related to IMF. First, fentanyl should be included on standard toxicology screens to facilitate early identification. Second, existing harm reduction strategies to identify likely fentanyl exposure should be adapted, such as training for bystanders that includes direct observation of anyone injecting or insufflating illicit opioids, ensuring that trained bystanders are equipped with sufficient doses of naloxone, expanding layperson training, and providing access to naloxone. Third, access and linkages to medication for opioid use disorders need to be enhanced in fentanyl-affected areas.