Top 5 Takeaways

  1. Para-fluorofentanyl, a Schedule I illicit fentanyl analog, was involved in 2.6% (1,658) of 64,915 overdose deaths across 43 jurisdictions from July 2020 to June 2021.
  2. The number of para-fluorofentanyl-involved deaths surged by 455.3%, from 253 in the latter half of 2020 to 1,405 in the first half of 2021.
  3. This substance was detected in 35 jurisdictions, with higher percentages in the Northeast (3.9%) and lower in the West (1.1%).
  4. Nearly all para-fluorofentanyl-related deaths co-involved illicitly manufactured fentanyl (IMF), with the rate of co-involvement ranging from 90.8% to 100%.
  5. The study acknowledges limitations, including potential underestimation of para-fluorofentanyl involvement due to inconsistent testing protocols and variations in death certification practices.

Original Article Author and Citation

Corresponding Author

Christine L. Mattson, .

Suggested Citation

Bitting J, O’Donnell J, Mattson CL. Notes from the Field: Overdose Deaths Involving Para-fluorofentanyl — United States, July 2020–June 2021. MMWR Morb Mortal Wkly Rep 2022;71:1239–1240. DOI:


The MMWR article reports on the increasing prevalence of para-fluorofentanyl in overdose deaths in the U.S. during July 2020 to June 2021. Para-fluorofentanyl is a potent fentanyl analog classified as a Schedule I illicit drug. Its emergence in drug overdose deaths poses new challenges in the ongoing opioid crisis.


The study analyzed overdose death data from the State Unintentional Drug Overdose Reporting System (SUDORS), encompassing death certificates and medical examiner and coroner reports. The analysis focused on the monthly frequency of overdose deaths involving para-fluorofentanyl across 42 states and the District of Columbia.


The marked increase in para-fluorofentanyl-related deaths indicates a potential shift in the illicit drug market. The high rate of co-involvement with IMF suggests either mixing of substances or emergence as a standalone product. The study’s limitations highlight the need for improved and standardized toxicology testing and certification processes.


To curb the rising tide of para-fluorofentanyl overdose and poisoning deaths, it is essential to provide widespread access to naloxone, harm reduction services, treatment services, and fentanyl test strips. Improved toxicology testing for emerging drugs like para-fluorofentanyl is also crucial.


This has been your booster shot of MMWR Info! Please check back for more MMWR, Public Health, and Programming Tutorial content daily.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>