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Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention

  • Michelle L. NolanEmail author
  • Sindhu Shamasunder
  • Cody Colon-Berezin
  • Hillary V. Kunins
  • Denise Paone
Article

Abstract

After remaining stable from 2010 to 2014, the  rate of cocaine-involved overdose death increased sharply from 2015 to 2016. This study aims to determine the contribution of opioids, and fentanyl in particular, to the increase in cocaine-involved overdose death from 2015 to 2016. Using New York City death certificate data linked to medical examiner toxicology data, we identified all overdose deaths where post-mortem toxicology results were positive for cocaine from 2010 to 2016. We analyzed cocaine-involved overdose deaths by co-occurring substances. Age-adjusted rates per 100,000 residents were calculated for 6-month intervals from 2010 to 2016. Data suggest that increased deaths involving opioids, specifically fentanyl, accounted for most of the increase in cocaine-involved deaths from 2015 to 2016.

Keywords

Overdose Fentanyl Opioid Cocaine Heroin 

Notes

Acknowledgements

The authors would like to thank Bennett Allen for his editorial assistance.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research was conducted with the support of the New York City Department of Health and Mental Hygiene. At the time the study was conducted, all authors were employees of the New York City Department of Health and Mental Hygiene. Authorization to submit and publish the enclosed manuscript was received from the institution.

Authors’ Contributions

Michelle Nolan and Sindhu Shamasunder had full access to study data and take responsibility for the accuracy of the data analysis. Michelle Nolan, Denise Paone, and Hillary Kunins were responsible for study concept and design and critical revision of the manuscript. Denise Paone, Michelle Nolan, Hillary Kunins, and Sindhu Shamasunder were responsible for the analysis and interpretation of the data. Michelle Nolan, Cody Colon-Berezin, and Sindhu Shamasunder contributed to manuscript drafting. All authors approved the final article as submitted on 31 May 2018.

References

  1. 1.
    Woodhead K, Wicker P. A textbook of perioperative care. Edinburgh; Elsevier/Churchill Livingstone; 2005.Google Scholar
  2. 2.
    Paone D, Nolan ML, Tuazon E, Blachman-Forshay J. Unintentional Drug poisoning (overdose) deaths in New York City, 2000–2016. New York: New York City Department of Health and Mental Hygiene; 2017.Google Scholar
  3. 3.
    Peterson AB, Gladden RM, Delcher C, et al. Increases in fentanyl-related overdose deaths - Florida and Ohio, 2013–2015. MMWR Morb Mortal Wkly Rep. 2016;65(33):844–9.CrossRefGoogle Scholar
  4. 4.
    CDC. Increases in fentanyl drug confiscations and fentanyl-related overdose fatalities. Atlanta: CDC; 2015.Google Scholar
  5. 5.
    Westley CH. Fact sheet: fentanyl-laced heroin and cocaine. In: Substance Abuse and Mental Health Services Administration, ed. Fact Sheet: SAMHSA, Rockville; 2013. Advailable online https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/dear_colleague_letters/2013-colleague-letter-fentanyl-analogues.pdf. Accessed 25 May 2018
  6. 6.
    Somerville NJ, O'Donnell J, Gladden RM, et al. Characteristics of fentanyl overdose - Massachusetts, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382–6.CrossRefGoogle Scholar
  7. 7.
    CDC. Acetyl fentanyl overdose fatalities--Rhode Island, March–May 2013. MMWR Morb Mortal Wkly Rep. 2013;62(34):703–4.Google Scholar
  8. 8.
    Jones CM, Baldwin GT, Compton WM. Recent increases in cocaine-related overdose deaths and the role of opioids. Am J Public Health. 2017;107(3):430–2.CrossRefGoogle Scholar
  9. 9.
    Fay MP, Feuer EJ. Confidence intervals for directly standardized rates: a method based on the gamma distribution. Stat Med. 1997;16(7):791–801.CrossRefGoogle Scholar
  10. 10.
    New York City Department of Health and Mental Hygiene. Presence of fentanyl in cocaine contributing to increase in drug overdose deaths; Health Advisory # 10, New York; 2017. Advailable online https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/fentanyl-advisory10.pdf. Accessed 25 May 2018
  11. 11.
    van Amsterdam J, Opperhuizen A, Koeter M, van den Brink W. Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population. Eur Addict Res. 2010;16(4):202–7.CrossRefGoogle Scholar
  12. 12.
    Palamar JJ, Mukherjee PP, Halkitis PN. A longitudinal investigation of powder cocaine use among club-drug using gay and bisexual men. J Stud Alcohol Drugs. 2008;69(6):806–13.CrossRefGoogle Scholar
  13. 13.
    Spectrum News. Health department warns NYers about cocaine laced with fentanyl in the city. New York: NY1; 2018.Google Scholar
  14. 14.
    Flynn G. It’s not rum and coke-but fentanyl and coke on L.E.S. New York: The Villager; 2018.Google Scholar

Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  • Michelle L. Nolan
    • 1
    Email author
  • Sindhu Shamasunder
    • 1
  • Cody Colon-Berezin
    • 1
  • Hillary V. Kunins
    • 1
  • Denise Paone
    • 1
  1. 1.Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental HygieneNew YorkUSA

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