Top 5 Takeaways

1. Significant Increase in Overdose Deaths: Drug overdose deaths in the U.S. increased by 28.5% from April 2020 to April 2021.
2. Emergence of Para-fluorofentanyl: Para-fluorofentanyl, a substance from the 1960s, has reemerged in the illicit drug market, found in heroin packets and counterfeit pills.
3. Introduction of Metonitazene: Metonitazene, a benzimidazole-opioid, has been increasingly encountered in combination with fentanyl in the U.S.
4. High Prevalence in Knox County: During November 2020–August 2021, 73% of unintentional drug overdose deaths in Knox County involved fentanyl, with para-fluorofentanyl and metonitazene also contributing significantly.
5. Increased Naloxone Requirement: Stronger opioids like para-fluorofentanyl and metonitazene may require additional doses of naloxone for effective overdose reversal.

Original Article Author and Citation

Corresponding Author

Jordan Trecki, Jordan.Trecki@dea.gov

Suggested Citation

Trecki J, Gerona RR, Ellison R, Thomas C, Mileusnic-Polchan D. Notes from the Field: Increased Incidence of Fentanyl-Related Deaths Involving Para-fluorofentanyl or Metonitazene — Knox County, Tennessee, November 2020–August 2021. MMWR Morb Mortal Wkly Rep 2022;71:153–155. DOI: http://dx.doi.org/10.15585/mmwr.mm7104a3

Summary

Data from the National Center for Health Statistics indicate a significant rise in drug overdose deaths in the U.S., with a 28.5% increase from April 2020 to April 2021. This increase is largely driven by opioids, with fentanyl and its analogs playing a major role. The Knox County Regional Forensic Center (KCRFC) identified para-fluorofentanyl and metonitazene in toxicology reports of overdose victims, highlighting their contribution to the rise in overdose deaths in eastern Tennessee.

Methods

The study utilized data from the National Forensic Laboratory Information System (NFLIS) and medical examiner reports from the Knox County Regional Forensic Center (KCRFC). Toxicology results from overdose victims were analyzed to identify the presence of fentanyl, para-fluorofentanyl, and metonitazene.

Discussion

The findings indicate a sharp increase in the presence of para-fluorofentanyl and metonitazene in the illicit drug market, contributing to the rise in overdose deaths. These substances, often found in combination with fentanyl, pose a significant risk due to their potent respiratory depressant effects. The increased distribution of these substances reflects a growing public health threat.

Conclusion

Physicians, medical examiners, and toxicology laboratories should be aware of the increased presence of para-fluorofentanyl and metonitazene. Public awareness and expanded naloxone availability are crucial to reducing opioid-related deaths. Additional doses of naloxone may be required for effective overdose reversal when stronger opioids are involved.

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