Health Outcomes and 1 more...less...

G3O5. Decrease those struggling with substance abuse

Number of deaths related to a synthetic opioid per annum

1,6452020

Line Bar
Story Behind the Curve

Drug overdoses are the leading cause of injury deaths in the United States. In 2020, more than 56,000 deaths involving synthetic opioids (other than methadone) occurred in the United States, which is more deaths than from any other type of opioid. Synthetic opioid-involved death rates increased by over 56% from 2019 to 2020 and accounted for over 82% of all opioid-involved deaths in 2020. The rate of overdose deaths involving synthetic opioids was more than 18 times higher in 2020 than in 2013 (1).

Synthetic opioids are substances that are synthesized in a laboratory and act on the same targets in the brain as natural opioids (e.g., morphine and codeine) to produce analgesic (pain relief) effects. In contrast, natural opioids are naturally occurring substances extracted from the seed pod of certain varieties of poppy plants. Some synthetic opioids, such as fentanyl and methadone, have been approved for medical use (2). 

The data above represenets deaths attributed to synthetic opioid in the state of Indiana. Death certificate data are used to track underlying and contributing cause of death, in order to understand the burden of drug overdose deaths for prevention. The underlying cause of death is the disease or injury that initiated the events leading to death while the contributing causes of death are diseases or injuries that contributed to the fatal outcome. Data are collected by the IDOH Division of Vital Records. A final dataset is provided by the IDOH, Office of Data and Analytics, Data Analysis Team and analyzed by the Division of Trauma and Injury Prevention to identify overdose deaths among Indiana residents. Deaths are reported back to the county of residence of the Indiana decedent (2).

Death certificate data are used to track underlying and contributing cause of death, in order to understand the burden of drug overdose deaths for prevention. The underlying cause of death is the disease or injury that initiated the events leading to death while the contributing causes of death are diseases or injuries that contributed to the fatal outcome. Data are collected by the IDOH Division of Vital Records. A final dataset is provided by the IDOH, Office of Data and Analytics, Data Analysis Team and analyzed by the Division of Trauma and Injury Prevention to identify overdose deaths among Indiana residents. Deaths are reported back to the county of residence of the Indiana decedent.

Drug overdose death counts involving synthetic opioids (displayed above) include the following codes:

Underlying Cause of Death Codes: 

  • X40 to X44 - Accidental poisoning by drugs
  • X60 to X64 - Intentional self-poisoning by drugs
  • X85 -  Assault by drug poisoning
  • Y10 to Y14 - Drug poisoning of undetermined intent

Contributing Cause of Death codes (for synthetic opoids): 

  •  T40.4  - Synthetic opioids

 

  1. CDC (2022). Synthetic Opioid Overdose Data. Retreived fom https://www.cdc.gov/drugoverdose/deaths/synthetic/index.html

What Works

Drug overdose deaths can be prevented. See how CDC is working to prevent overdoses and substance use-related harms with guideling principles and strategic priorities.

Ten Evidence-Based Strategies for Preventing Opioid Overdose

  1. Targeted Naloxone Distribution  
  2. Medication-Assisted Treatment (MAT)  
  3. Academic Detailing  
  4. Eliminating Prior-Authorization Requirements for Medications for Opioid Use Disorder  
  5. Screening for Fentanyl in Routine Clinical Toxicology Testing  
  6. 911 Good Samaritan Laws  
  7. Naloxone Distribution in Treatment Centers and Criminal Justice Settings  
  8. MAT1 in Criminal Justice Settings and Upon Release  
  9. Initiating Buprenorphine-based MAT in Emergency Departments  
  10. Syringe Services Programs 

 

See more additional Evidence-Based Strategies for Preventing Opioid Overdose here

Challenges

Previous reports have indicated that increases in synthetic opioid-involved deaths have been associated with the number of drug submissions obtained by law enforcement that test positive for fentanyl but not with fentanyl prescribing rates. These reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical (2,3,4). 

There are also fentanyl analogs, such as acetylfentanyl, furanylfentanyl, and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Recent surveillance has also identified other emerging synthetic opioids, like U-47700 (5). Estimates of the potency of fentanyl analogs vary from less potent than fentanyl to much more potent than fentanyl, but there is some uncertainty because potency of illicitly manufactured fentanyl analogs has not been evaluated in humans. Carfentanil, the most potent fentanyl analog detected in the U.S., is estimated to be 10,000 times more potent than morphine (5,6). 

Many illicitly produced synthetic opioids are more potent than morphine and heroin and thus have the potential to result in a fatal overdose (7).

Sources 

  1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at http://wonder.cdc.gov.
  2. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at http://wonder.cdc.gov.
  3. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths – 27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43.
  4. Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2013-2015. Morb Mortal Wkly Rep. 2016;65(33):844-9.
  5. O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903.
  6. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202.
  7. https://www.dea.gov/sites/default/files/2020-06/Synthetic%20Opioids-2020.pdf
  8. CDC (2022). Synthetic Opioid Overdose Data. Retrieved from https://www.cdc.gov/drugoverdose/deaths/synthetic/index.html
Corrective Action
PoE

IDOH Overdose Prevention Records

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy