Insights From State Data Into Deaths Related to Fentanyl, Fentanyl Analogs, Psychostimulants, and Novel Psychoactive Substances

Novel psychoactive substances (NPS), which vary widely in effect, potency, availability, and legal status, have increasingly contributed to nonfatal and fatal drug overdoses. Better understanding demographics and circumstances associated with NPS overdose deaths could inform prevention efforts. The Center for Disease Control and Prevention’s (CDC’s) Overdose Data to Action program funds 47 states and the District of Columbia to abstract fatal overdose data from death certificates, medical examiner/coroner reports, and toxicology results into the State Unintentional Drug Overdose Reporting System (SUDORS). Data from 42 jurisdictions were analyzed to examine demographics and characteristics of overdoses during January 2019–June 2020 with select NPS detected on postmortem toxicology (“NPS-positive”): fentanyl analogs, illicit benzodiazepines, benzimidazoles, cathinones, U-series drugs, and synthetic cannabinoids. NPS were detected in 9,316 of 66,707 overdose deaths (14.0%); ≥1 fentanyl analog was detected in 8,149 NPS-positive deaths (87.5%). Most NPS-positive deaths were among males (71.7%), non-Hispanic Whites (73.1%), and persons aged 25–44 (56.9%). Higher percentages of benzimidazole- and synthetic cannabinoid-positive deaths were among males (77.6% and 83.5%, respectively); lower percentages of cathinone- and synthetic cannabinoid-positive deaths were among non-Hispanic Whites (44.9% and 42.2%, respectively). Fentanyl was also detected in 18.1% of synthetic cannabinoid-positive deaths, but in >50% of other NPS-positive deaths (including 94.4% of fentanyl analog deaths). Naloxone was administered in approximately one-quarter of NPS-positive deaths (including non-opioid NPS). During January 2019–June 2020, NPS were detected in approximately one in seven overdose deaths. SUDORS allows for tracking NPS and identifying characteristics of NPS-positive overdoses and decedents to tailor and inform prevention efforts.

In the United States, deaths from synthetic opioids increased by over 15% from 2018 to 2019 with Kentucky, Florida, and Illinois all reporting significant increases. Deaths attributable to psychostimulants have created new concerns of a “fourth wave” in the national drug overdose epidemic. Kentucky, Florida, and Illinois each has a unique drug overdose surveillance system that provides novel epidemiologic insight on deaths associated with fentanyl, fentanyl analogs, and psychostimulants. Florida’s Department of Law Enforcement Medical Examiners’ surveillance system provides detailed toxicology data that helped elucidate a carfentanil outbreak in the state. Kentucky’s Drug Overdose Fatality Surveillance System links data from death certificates, autopsies, toxicology tests, controlled substance prescriptions, and coroner narratives giving a clearer profile of the risk/protective factors associated with these fatalities. In Illinois, the Cook County Medical Examiner’s office has adopted an open data approach to reporting their fatal drug poisonings, which, combined with other geographic data, is enabling new understanding about the neighborhood and other locations in which these deaths occur.