Delcher Chris, Shin Eugene, Iyer Arjun, Johnson Trokon K, Winokur Agnes D, Goldberger Bruce A
Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY 40508, USA.
Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY 40508, USA.
Drug Alcohol Depend. 2025 Sep 1;274:112784. doi: 10.1016/j.drugalcdep.2025.112784. Epub 2025 Jul 7.
In 2016 and 2017, carfentanil was implicated in the deadliest fatal outbreak involving a fentanyl analog in the United States with 1190 deaths in Florida alone. Recent surveillance signals suggest that Florida is experiencing a resurgence in carfentanil-involved deaths. The purpose of this paper is to examine carfentanil-involved overdoses using up-to-date medical examiners reports triangulated with carfentanil-related indicators at multiple levels.
Florida's medical examiner data were analyzed in three periods (2016, 2017, 2018-2023) to examine changes in decedent demographic, geographic, and toxicologic characteristics. We triangulated six additional state and national data sources which included completed death certificates, the National Forensic Laboratory Information System, Reddit mentions, and clinical urine drug tests positive for carfentanil.
There were 24 carfentanil-involved deaths in a 2-month period (Dec/Nov 2023). Compared to 2017, recent decedents were significantly older (42.9 years old vs. 37.1 years old, p < 0.0001) with increased exposure to fentanyl (23.4-68.8 %, p < .0001) and methamphetamine (8.5-20.4 %, p = 0.0003). The state's prior three-county epicenter showed limited involvement (6.5 % vs. 18.9 % total carfentanil deaths) when compared to the prior outbreak. All triangulated national data sources showed strong retrospective concordance. More timely death certificate data suggests that monthly carfentanil deaths were more frequent (mean=4 deaths/mo.) in 2024.
The state may have averted a fatal outbreak as of December 2024, but carfentanil deaths have reached new monthly levels with increasingly active signals in other systems. These systems should be monitored regularly to decrease lag time in fatal overdose surveillance for a faster public health response.
2016年和2017年，卡芬太尼在美国引发了涉及芬太尼类似物的最致命的致命疫情，仅在佛罗里达州就造成1190人死亡。最近的监测信号表明，佛罗里达州涉及卡芬太尼的死亡人数正在回升。本文的目的是利用最新的法医报告，并结合多个层面与卡芬太尼相关的指标，来研究涉及卡芬太尼的过量用药情况。
对佛罗里达州法医数据在三个时期（2016年、2017年、2018 - 2023年）进行分析，以研究死者人口统计学、地理和毒理学特征的变化。我们整合了另外六个州和全国性的数据源，包括完整的死亡证明、国家法医实验室信息系统、Reddit提及的内容以及卡芬太尼临床尿液药物检测呈阳性的结果。
在2023年11月/12月的两个月期间，有24例涉及卡芬太尼的死亡。与2017年相比，近期死者年龄显著更大（42.9岁对37.1岁，p < 0.0001），接触芬太尼的比例增加（23.4 - 68.8%，p < 0.0001），接触甲基苯丙胺的比例增加（8.5 - 20.4%，p = 0.0003）。与之前疫情相比，该州之前的三个县的疫情中心参与程度有限（占卡芬太尼死亡总数的6.5%对18.9%）。所有整合的全国性数据源都显示出很强的回顾性一致性。更及时的死亡证明数据表明，2024年每月卡芬太尼死亡人数更为频繁（平均 = 4例/月）。
截至2024年12月，该州可能避免了一场致命疫情，但卡芬太尼死亡人数已达到新的月度水平，其他系统中的信号也越来越活跃。应定期监测这些系统，以减少致命过量用药监测中的滞后时间，以便更快地做出公共卫生反应。
