CDC Health Update – Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds

Has your Emergency Department seen an increase of patients overdosing on fentanyl?  The CDC recently issued a Health Update to alert healthcare providers to new developments that have placed more people at risk for fentanyl-involved overdoses from illicitly manufactured fentanyl (IMF) that may increase the risk of non-fatal and fatal overdose. These developments include:

• A sharp increase in the availability of counterfeit pills containing varying amounts of fentanyl and fentanyl-related compounds (e.g., labeled as Oxycodone, Xanax, and Norco)
• The potential for counterfeit pills containing fentanyl and fentanyl-related compounds to be broadly distributed across the United States which could impact states not previously impacted by IMF and persons using diverted prescription pills (i.e., illicit drugs diverted for illicit purposes and involves the diversion of drugs from legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary)
• The widening array of toxic fentanyl-related compounds being mixed with heroin or sold as heroin, including extremely toxic analogs such as carfentanil
• Continued increases in the supply and distribution of IMF

In July 2016, the Drug Enforcement Administration (DEA) issued a nationwide report indicating that hundreds of thousands of counterfeit pills have been entering the U.S. drug market since 2014, some containing deadly amounts of fentanyl and fentanyl analogs. Traditionally, fentanyl and fentanyl analogs in the illicit market have been mixed into heroin or sold as heroin, often without the knowledge of the consumer, and have primarily impacted areas where white powder heroin is prevalent, including the Northeast, Midwest, and Southeast regions of the United States.

The influx of counterfeit pills, which closely resemble oxycodone, Xanax, and Norco, has increased the chance of fentanyl-involved overdoses among persons misusing prescription opioids or benzodiazepines who seek diverted medications on the illicit market, in addition to persons who inject, sniff, or snort drugs. Persons who misuse prescription pills are geographically widespread; thus, the potential risk for fentanyl overdose has spread beyond those regions previously known to be impacted by IMF, and could intensify the impact in regions already affected by IMF.

The CDC’s Health Alert contains numerous recommendations in response to the increased risk of fentanyl overdose from IMF due to the influx of fentanyl-laced counterfeit pills and the widening array of highly toxic fentanyl-related compounds.  Recommendations for healthcare providers include:

• A reminder that multiple dosages of naloxone may need to be administered per overdose event, because of fentanyl’s increased potency relative to other opioids.
  • Orally-ingested counterfeit pills laced with fentanyl may require prolonged dosing of naloxone in the ED/hospital setting due to a delayed toxicity that has been reported in some cases.
• Facilitate access to Medication-Assisted Treatment (MAT).
  • MAT is a comprehensive approach to addressing the needs of persons with opioid use disorders that combines the use of medication with counseling and behavioral therapies.  Treatment options should be discussed with individuals who have an opioid use disorder, and individuals who have experienced an opioid-related overdose once they are stabilized.

The CDC Health Update also includes recommendations for Public Health Departments, Medical Examiners and Coroners, Law Enforcement and Laboratories.

 

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