Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016

Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review

“…Atypical overdose characteristics have also been reported after usage of fentanyl and fentanyl analogs. In a retrospective study regarding opioid deaths in Massachusetts from 2012-2014, uncommon symptoms included immediate blue discoloration of the lips (20%), gurgling sounds with breathing (16%), stiffening of the body or seizure-like activity (13%), foaming at the mouth (6%), and confusion or strange affect before unresponsiveness (6%) (Somerville et al, 2017). In addition, chest wall rigidity is thought to be a cause of rapid death after fentanyl usage (Burns et al, 2016) Rare adverse effects after fentanyl usage include diffuse alveolar hemorrhage immediately after insufflating fentanyl powder in a 45 year old male who developed hypoxic respiratory failure (Ruzycki et al, 2016).…”

“…Of these, 83% reported needing 2 or more naloxone doses before a response was seen (2 mg IN per dose). During the study time period, fentanyl was the primary illicit opioid in the state (Somerville et al, 2017). During the 2006 fentanyl outbreak, naloxone was given in 26/55 (47.3%) of ED visits in one study cohort.…”

Fentanyl in the US heroin supply: A rapidly changing risk environment

“…Clearly use patterns and perceptions are moving targets with local and evolving cultural norms and degrees of adaptation. Pharmaceutical fentanyl has been reported to have some desirability in survey studies (Firestone, Goldman, and Fischer 2009) as well as controlled settings (Greenwald 2008), but in the current epidemic the fentanyl is illicitly manufactured (Somerville et al 2017) and surreptitiously sold, not self-chosen pharmaceutical product.…”

“…The InSite program in Vancouver, Canada was successful in reducing population level fatal overdose rates (Marshall et al 2011). Given that fentanyl overdose is a rapid event with a narrow therapeutic window (Somerville et al 2017, Green and Gilbert 2016) supervised injection facilities make sense in addressing the fentanyl overdose epidemic, yet they are underutilized in the host spot of the epidemic – North America (Marshall et al 2017). In addition, innovations in supervised injection or safe drug consumption rooms are needed, e.g., in location, size, adaptability, cost, mobility etc.…”

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

“…Although it is challenging to study because of unmeasured forces influencing opioid overdose, existing data from settings where fentanyl and other synthetic opioids have already contaminated the illicit drug market continue to suggest real benefits of naloxone (Somerville et al, 2017). Moreover, an important component of community overdose prevention programs is education that empowers people who use drugs to reduce overdose risk.…”