Fentanyl is overwhelmingly the most commonly detected opioid nationally, although geographical differences are present for opioids, poly-drug use and novel psychoactive substances (NPS), according to a quarterly report recently published by The Center for Forensic Science Research & Education (CFSRE).
The clinical report is the result of a partnership between the American College of Medical Toxicology (ACMT) and the CSFRE. When patients present to emergency departments within ACMT’s Toxicology Investigators Consortium experiencing a suspected opioid overdose, researches collect residual, discarded biological samples for testing.
“Our findings provide a real-time assessment of the drug market and allude to resulting implications on clinical institutions,” wrote CSFRE in the report.
The Q3 2022 report focuses on eight cities across seven states—Pittsburgh and Bethlehem, Penn.; New York; Newark, NJ; St. Louis, Mo.’ Portland, Ore.; Los Angeles; Grand Rapids, Mich.
In all eight cities, fentanyl was the most commonly detected opioid, ranging from 68% in Portland to as high as 97% in Bethlehem. Additionally, researchers detected at least two new NPSs in all eight cities—with p-fluorofentanyl showing up in each one. The highest amount of para-fluorofentanyl, found in 25% of samples, was observed separately in both Pennsylvania cities.
This data jives with a memo released by the CDC in October, noting the health agency’s increased detection of para-fluorofentanyl. The first occurrence of para-fluorofentanyl–involved overdose deaths was recorded in September 2020. That number continued to increase through the end of the year, with 253 deaths from September to December 2020. Then, the first six months of 2021 unfolded differently. From January to June 2021, para-fluorofentanyl–involved deaths increased 455% from 253 to 1,405 recorded overdose deaths.
While the CDC noted that para-fluorofentanyl–involved deaths nearly always co-involved fentanyl in 2020 and 2021, the real-time analysis of late-2022 trends by CSFRE reveals that is no longer the case. CSFRE researchers detected para-fluorofentanyl without fentanyl in three of the eight cities—Bethlehem, Los Angeles and Grand Rapids.
At this time, little is known about para-fluorofentanyl, which is likely similar to or slightly less potent than fentanyl. However, the real-time increase CSFRE has seen, as well as the analog’s detection without fentanyl, may indicate it is rising in popularity.
Other NPS observed by city include:
- Pittsburgh: clonazolam
- Bethlehem: o-fluorofentanyl, valerylfentanyl, ADB-PINACA
- New York: bromazolam, flubromazepam, MDMB-4en-PINACA
- Newark: clonazolam
- St. Louis: bromazolam, flubromazepam
- Portland: bromazolam
- Los Angeles: o-fluorofentanyl
- Grand Rapid: clonazolam, flualprazolam
In New York and Newark, PCP was detected alongside fentanyl, while in St. Louis, MDMA was detected alongside the synthetic opioid.
Heroin and methadone were the most commonly detected after fentanyl, but the percentage discrepancy is telling. For example, while 75% of samples in Los Angeles contained fentanyl, only 5% contained heroin and 5% contained methadone. The numbers are similar throughout every sampled city, with heroin and methadone never higher than 25% and fentanyl rarely lower than 70%.
All analysis of biological samples was performed via liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS). The scope of testing targeted more than 1,000 drugs, including a vast majority of NPS and metabolites. Drug classes included opioids, benzodiazepines, cannabinoids, stimulants and hallucinogens, among other drugs.