Opioid overdose deaths in Massachusetts increased 150% from 2012 to 2015 (1). The proportion of
opioid overdose deaths in the state involving
fentanyl, a synthetic, short-acting
opioid with 50-100 times the potency of
morphine, increased from 32% during 2013-2014 to 74% in the first half of 2016 (1-3). In April 2015, the Drug Enforcement Agency (DEA) and CDC reported an increase in law enforcement
fentanyl seizures in Massachusetts, much of which was believed to be illicitly manufactured
fentanyl (IMF) (4). To guide overdose prevention and response activities, in April 2016, the Massachusetts Department of Public Health and the Office of the Chief Medical Examiner collaborated with CDC to investigate the characteristics of
fentanyl overdose in three Massachusetts counties with high
opioid overdose death rates. In these counties, medical examiner charts of
opioid overdose decedents who died during October 1, 2014-March 31, 2015 were reviewed, and during April 2016, interviews were conducted with persons who used illicit
opioids and witnessed or experienced an
opioid overdose. Approximately two thirds of
opioid overdose decedents tested positive for
fentanyl on postmortem toxicology. Evidence for rapid progression of
fentanyl overdose was common among both fatal and nonfatal overdoses. A majority of interview respondents reported successfully using multiple doses of
naloxone, the
antidote to
opioid overdose, to reverse suspected
fentanyl overdoses. Expanding and enhancing existing
opioid overdose education and prevention programs to include
fentanyl-specific messaging and practices could help public health authorities mitigate adverse effects associated with overdoses, especially in communities affected by IMF.