As the overdose epidemic rages on, the Centers for Disease Control and Prevention (CDC) has released information on the increased detection of para-fluorofentanyl, a schedule I illicit fentanyl analog.
Previous analyses identified para-fluorofentanyl in drug overdose deaths in eight states from late 2020 through June 2021. But, little is known about the analog—which is likely similar to or slightly less potent than fentanyl—and even less is known about its role in the illicit drug market and opioid overdose crisis.
To better understand the market and trends, the CDC analyzed monthly frequencies of overdose deaths during July 2020 to June 2021 involving para-fluorofentanyl among 42 states and the District of Columbia.
The first occurrence of para-fluorofentanyl–involved overdose deaths occurred in September 2020, with the report of five deaths. That number continued to increase through the end of the year, with 253 deaths from September to December 2020.
Then, the first size months of 2021 told a different story. From January to June 2021, para-fluorofentanyl–involved deaths increased 455% from 253 to 1,405 recorded overdose deaths.
Overall, para-fluorofentanyl was involved in 1,658 (2.6%) of 64,915 overdose deaths reported by the 43 jurisdictions from September 2020 to June 2021. The deaths accounted for 3.9%, 2.9%, 1.9% and 1.1% of overdose deaths in included jurisdictions in the Northeast, South, Midwest, and West U.S. Census Bureau regions, respectively. Six states—Illinois, Maryland, Michigan, New Jersey, Pennsylvania and Tennessee—reported more than 100 deaths involving para-fluorofentanyl.
Unsurprisingly, para-fluorofentanyl–involved deaths nearly always co-involved fentanyl. According to the CDC, co-involvement ranged from 100% of deaths in September 2020 to 90.8% in June 2021.
“Because of high co-involvement with [fentanyl], it is unclear whether the proliferation of para-fluorofentanyl reflects a diversification of the illicit drug market—i.e., para-fluorofentanyl is being mixed with illicitly manufactured fentanyl—or it has emerged as a new standalone product,” the public health agency said in a recent statement.
The early detection of analogs and novel psychoactive substances is critical to making headway opioid overdose crisis. Forensic scientists, medical examiners and coroners are, oftentimes, the first to come across evolving trends in the illicit drug market.
“It is unclear whether para-fluorofentanyl poses a higher risk than does fentanyl alone; however, access to and timely administration of naloxone to reverse opioid overdoses, as well as ensuring access to substance use prevention and treatment services, including distribution of fentanyl test strips, is crucial to prevent para-fluorofentanyl overdose deaths,” said the CDC. “Because the market continues to evolve rapidly and some jurisdictions might have a lack of or limited testing capabilities, a critical need also exists for expanded, enhanced toxicology testing to detect para-fluorofentanyl and other emerging drug.”
The latest available statistics from the CDC indicate that synthetic opioids, including illicitly manufactured fentanyl, were involved in approximately 2/3 of an estimated 108,174 overdose deaths in the U.S. from April 2021 to April 2022.