ATrain Education

 

Continuing Education for Health Professionals

Fentanyl: Scourge of the Opioids

Module 2

The Painful Numbers of Opioids

The CDC has declared the overuse and abuse of opioids an epidemic (Hedegaard, 2014; Rudd et al., 2016). Ninety-one Americans die every day from an opioid overdose (CDC, 2017, NCHS, 2017). Drug-related deaths have more than tripled from 6 people per 100,000 in 1999 to 16 per 10,000 in 2015 (NCHS, 2017). The United States consumes 99% of all the world’s hydrocodone, 80% of the world’s oxycodone, and 65% of the world’s hydromorphone prescription opiate supply. Twenty-five percent of all workers’ compensation costs relate to opioids and $56 billion per year is spent on opioid abuse costs.

Trends of opioid overdose–related deaths in the United States have increased 5.5% annually from 6 deaths per 100,000 people in 1999 to 16.3 in 2015. In adults aged 45 to 54 the death rate from drug overdose was the highest of all age populations, showing a constant trend upward of 10% annual increase in abuse and deaths (NCHS, 2017). Clearly, America has an opioid epidemic that is claiming lives and lifestyles. Additional statistics, not as easily identified but very real, are the lost productivity in work hours and loss of meaningful lives, families, and marriages due to opioid abuse (ASAM, 2016).

A study examined deaths in 27 states from 2013 to 2014 and fentanyl-laced drug products increased by 426% (Gladden et al., 2016). It is estimated that the true numbers of synthetic opioid–related deaths are much higher because mixtures of fentanyl with heroin or cocaine are not always tested. The Drug Enforcement Agency (DEA) reports that fentanyl chemicals (illicitly manufactured fentanyl products) are mostly coming from Asian laboratories, mainly China; fentanyl was not a controlled substance until 2017 (Prekupec et al., 2017).

 

Deaths from Overdose by Year (1999–2015)

chart of overdose deaths by year and age

1Significant increasing trend, p < 0.005.
2Rate for age group 45–54 in 2015 was significantly higher than for any other age group, p < 0.001.
NOTES: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Access data table for this figure at: https://www.cdc.gov/nchs/data/databriefs/db273_table.pdf#2. Figure is available at: https://www.cdc.gov/nchs/products/databriefs/db273.htm.
SOURCE: NCHS, National Vital Statistics System, Mortality.

 

Opioid drugs include:

Natural opioids

  • Morphine
  • Codeine (only available in generic form)
  • Thebaine

Semi-synthetic opioids

  • Hydrocodone (Hysingla ER, Zohydro ER)
  • Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
  • Hydromorphone (Dilaudid, Exalgo)
  • Oxycodone (OxyContin)
  • Heroin

Fully synthetic/manmade opioids

  • Fentanyl (Actiq, Duragesic, Fentora, Sublimaze)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Tramadol
  • Levorphanol
  • Pethidine
  • Dextropropoxyphone

Whereas natural opiates come from the opium plant and the active ingredient is morphine, semi-synthetic opioids are those created in laboratories and include hydromorphone, hydrocodone, and oxycodone, plus the illegal drug heroin. All of these are called narcotics and are schedule II drugs, except for heroin, which is an illegal schedule I drug and has not been approved for any medical use.

The fully synthetic drugs such as fentanyl are much more potent and have higher potential for abuse and death (Prekupec et al., 2017). Deaths caused by illicitly manufactured fentanyl (IMF) related overdoses have increased from 550 in 2013 to more than 2,000 deaths in 2015 (USDJ, 2016). National estimates of illegal fentanyl use come from the state and local forensic laboratories and drug seizure incidents. Trends reveal that the states reporting more fentanyl use are in the South or Midwest. States reported no more than 14 incidences in 2001, whereas, by 2015 all but one state had 100 or more reports (DEA, 2017). Cities that ranked highest for incidences include Cincinnati, Pittsburg, Baltimore, and South Charleston.

Ohio forensic testing in 2017 revealed 99% of their narcotic overdose deaths were fentanyl-related and often due to combinations of IMFs, including 25 fentanyl analogs such as acryl fentanyl, nor fentanyl and furanyl fentanyl. The state also determined that males accounted for 64% of overdose deaths and 92% were white (CDC, 2017). Over half of the deaths in Ohio were in persons aged 25 to 44 years (Carlson, 2015; Peterson, 2016).

There were over 65,000 deaths due to fentanyl in 2016, which was up from 52,000 in 2015. The death rate due to fentanyl is much higher than the peak deaths due to fatal car crashes of 60,000 in 1972, HIV of 50,000 in 1995, and gun deaths of 40,000 in 1993. Trends continue to rise and causes point to the increased prescriptions of opioids for chronic pain and the availability of these drugs in non-prescription form.

 

Answer: B

Test Your Knowledge

Which of the following is not an opioid?

  1. Morphine
  2. Cocaine
  3. Hydrocodone
  4. Fentanyl

Apply Your Knowledge

You are a medical/surgical nurse and your patient is complaining of pain rated at 7/10 who has orders for hydrocodone. What nonpharmacologic options do you have to help with pain reduction? How often do you try to offer those to your patients? Is your health care facility supportive of your efforts to offer nonpharmacologic options for pain control?

Online Resource

Your Brain on Fentanyl (3:44)

https://www.youtube.com/watch?v=C0tW8FWBm1g

    Instructions
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