264 Trends and Characteristics of Fentanyl Exposures Reported to the US Poison Centers

Abstract

Overdoses due to synthetic opioids increased by 45% between 2016 and 2017, primarily driven by fentanyl and analogs. Although between 2016 and 2017, more than 5 million prescriptions were dispensed, there is a paucity of nationally representative U.S. fentanyl overdose data. This study aims to examine the national trends in tramadol exposures reported to U.S. poison centers (PCs). The National Poison Data System (NPDS) was queried for all fentanyl exposures from 2013 to 2019. We identified and descriptively assessed the relevant demographic and clinical characteristics. Fentanyl reports from acute care hospitals and Emergency Departments (ACHs) were analyzed as a sub-group. Trends in frequencies and rates (per 100,000 human exposures) were analyzed using Poisson regression methods. Percent changes from the first year of the study (2013) were reported with the corresponding 95% confidence intervals (95% CI). There were 12,843 fentanyl exposures reported to the PCs from 2013 to 2019, with the calls increasing from 1,544 to 2,761 during the study period. Confirmed reports of illicit fentanyl overdoses grew from 3 reports in 2013 to 141 in 2019. The proportion of calls from ACH increased from 64% to 67.4% during the study. Multiple substance exposures accounted for 69.9% of the overall fentanyl calls and 53.4% of the calls from ACH. The most frequent co-occurring substances reported were benzodiazepines (15.5%) and heroin (7.2%). Residence was the most common site of exposure (80.1%) and 73.1% cases were enroute to the hospital when the PC was notified. Tachycardia and respiratory depression were the most frequently demonstrated clinical effects. Naloxone was a reported therapy for 44.1% cases, with this therapy being performed prior to PC contact in most cases. Demographically, 55.5% of cases were males, and the most frequent age groups were 20-29 years (22.5%) and 30-39 years (21.3%). Intentional misuse (41.4%) and suspected suicides (16.8%) were commonly observed reasons for exposure, with the proportion of suicides being higher in cases reported by ACH (22.8%). Approximately 22% of the patients reporting fentanyl exposures were admitted to the critical care unit (CCU). Major effects were seen in 18.2% cases and the case fatality rate was 9.2%, with deaths increasing significantly during the study period (62 deaths in 2013 to 1,184 deaths in 2019). The frequency of exposures increased by 78.8% (95% CI: 68%, 90.3%; p<0.001), and the rate of exposures increased by 82.3% (95% CI: 36.3%, 143.9%; p<0.001). PC data demonstrated an increasing trend of fentanyl exposures, which may in part be attributed to the due to increased use of illegally or illicitly made fentanyl. A significant proportion of fentanyl exposures were associated with intentional abuse, suicide and increasing mortality. Fentanyl exposure reports from acute care hospitals and EDs during the study increased.