Ricerc@Sapienza

The National Institute on Drug Abuse in the U.S. has observed an increase in the deaths from synthetic opioids (mainly fentanyl) in recent years. Several epidemics related to the illicit abuse of fentanyl and its analogs have been reported in the Country: one of those happened in Cook County in 2005-2007 (350 individuals). Another outbreak of fentanyl death occurred in 2015-2017 in the same area. The electronic database of the Cook County Medical Examiner’s Office in Chicago was searched for cases of death involving fentanyl and fentanyl analogs toxicity between October 2015 and December 2017. A total of 27,131 deaths were identified in the studied period. Among these, 1,244 cases (4.5%) satisfied the requirements of the study. The population was divided into two subpopulations: 927 deaths involving fentanyl and 317 deaths involving fentanyl analogs (without fentanyl). Most of the cases involved Caucasian males. The mean age was 44 years old, and the study population ranged between 14 and 77 years. The mean fentanyl concentration in post-mortem peripheral blood was 18.19 ng/ml (range: 0.11-464). A progressively increasing number of cases/year was observed from 2015 to 2017: 56 in October-December 2015, 540 in 2016 and 648 in 2017. In the vast majority of 2015-2017 fentanyl cases, fentanyl was associated with other products: the most common drug used with fentanyl was heroin, followed by cocaine and ethanol. Statistical comparisons with the 2005-2007 population were performed, showing an increase in the number of cases by 2.6 times. In both the 2005-2007 and 2015-2017 populations, the majority of deaths involved males, but a significant increase in the number of females was observed in the 2015-2017 group. Regarding the race of the decedents, in 2005-2007 the majority of deaths occurred among African Americans, while in 2015-2017 the majority of deaths involved Caucasians. In addition, some combinations of drugs were significantly more common in specific demography subgroups (male/females; Caucasian/African American; certain age groups): this could be due to an increased use/choice of these combinations in these groups, or to a possible greater susceptibility of these groups to the effect of some specific drugs association. Knowledge about the new fentanyl outbreak could be useful for public health in monitoring and quickly diagnosing and treating acute intoxication when fentanyl is involved. Moreover, the analysis of the recreational drugs usually combined with fentanyl can contribute to a better-informed public policy that helps reduce the risk for drug abusers.