At least 70 deaths in Washington state in 2016 were linked to fentanyl or other similar synthetic opioids, according to an investigation by state agencies and the University of Washington. As part of the study, Dr. Caleb Banta-Green, affiliate associate professor at the University of  Washington School of Public Health, analyzed 41 of the fentanyl-related deaths to find out how the drugs are being obtained and used.

[Photo: Dr. Caleb Banta-Green]

In a report published online, Dr. Banta-Green, also a principal research scientist at the Washington’s Alcohol and Drug Abuse Institute (ADAI), says there are “clear warning signs of a possible emergent drug phenomenon involving illicit fentanyl and non-Rx-type-fentanyls.” These are opioids that are not legally permitted or authorized by a prescribing physician.

Using medical examiners’ data from King, Pierce, Snohomish and Spokane counties, Dr. Banta-Green found that 18 of the 41 deaths involved unknown types of fentanyl and 14 involved illicit, non-pharmaceutical fentanyl. Nine of the deaths involved pharmaceutical products that may have been prescribed.

“Fentanyl-related drugs are present in a substantial minority of cases, and pharmaceutical fentanyl in a small proportion of cases,” Dr. Banta-Green said. “The source and form of these non-pharmaceutical drugs is hard to determine, but appears to be often purchased on the street or online, and often in the form of a powder or pill that looks like a real pharmaceutical such as an opioid or a benzodiazepine.”

Fentanyl bought on the street or on the internet may have unpredictable levels of potency, making it hard to use a known or consistent amount or even to know what drug you are taking.

Deaths linked to pharmaceutical fentanyl occurred among the oldest individuals and included the only two recorded suicides. Deaths linked to unknown forms of fentanyl occurred among the youngest individuals, with an average age of 29 years.

Dr. Banta-Green’s report was part of an investigation conducted by the Washington State Department of Health, the State Toxicology Laboratory, Public Health – Seattle & King County and ADAI. The collaboration also published a more comprehensive report detailing the increase in fentanyl-related overdose deaths in Washington state from 2015 to 2016, which roughly doubled.

“While we still have a lot to learn about how these drugs are influencing drug use and overdoses in our state, this report answers some of our initial questions and gives us some insight to help shape our response to this challenge,” said State Health Officer Dr. Kathy Lofy. “We are committed to do as much as we can to prevent opioid-related deaths in our state, and we’ll use what we’ve learned to help shape future work.”

Dr. Lofy is also a clinical professor of health services at the School of Public Health. Dr. Jeffrey Duchin, health officer at Public Health – Seattle & King County and adjunct professor of epidemiology at SPH, also took part in the investigation.

Link to Dr. Banta-Green’s report: http://adai.uw.edu/pubs/pdf/2017fentanyldeaths.pdf

Link to the DOH report: http://www.doh.wa.gov/Portals/1/Documents/1600/DOHFentanylReport2017Final.pdf