Carfentanil and Current Opioid Trends in Summit County, Ohio

Area of Science:

• Forensic Toxicology
• Public Health
• Opiate Crisis Research

Background:

• Summit County Medical Examiner's Office (SCMEO) noted a surge in suspected drug overdose deaths in July 2016.
• Initial immunoassay tests for fentanyl were positive, but GC/MS failed to confirm. Reference lab testing identified carfentanil as the cause.

Purpose of the Study:

• To develop an in-house method for identifying carfentanil due to a high case volume.
• To conduct a retrospective analysis of all drug overdose cases from 2009-2016 in Summit County.

Main Methods:

• Development of an in-house carfentanil identification method using available instrumentation.
• Retrospective analysis of the SCMEO database for drug overdose cases between January 2009 and December 2016.

Main Results:

• A 277% increase in yearly overdose fatalities was observed between 2009 and 2016.
• Carfentanil was first detected in July 2016, leading to an initial spike of 35 deaths in July and August.
• Carfentanil was found both as a single agent and in combination with other illicit drugs.

Conclusions:

• Carfentanil concentrations in overdose cases appear to be decreasing but may be present with other fentanyl analogs.
• Lower carfentanil concentrations are challenging to detect in urine and peripheral blood.
• Testing of scene paraphernalia, central blood, and organ tissue is crucial for accurate identification.