fentanyl: trend-spotting overview and focus on deaths · • ews signals - misuse of synthetic...
TRANSCRIPT
Fentanyl: trend -spotting overview and focus on deaths
Jane MounteneyEMCDDA
2
Trendspotter - concept
• In depth information gathering
• On subject of concern, uncertainty
• One off and ad hoc
• Rapid reporting
3
Trendspotter methods
Multi source, multi-method, multi-disciplinary, triangulation:
• Literature review• Routine data collection• Electronic survey • MEETING• Expert presentations • Work groups • Analysis
4
2012 Fentanyl trendspotter study
AimTo increase our understanding of the illicit use and availability of fentanyl in Europe, in particular:
• extent and patterns of illicit fentanyl use• illicit production and diversion • harms and deaths linked with fentanyl use• responses
5
Impetus…for the study
• EWS signals - misuse of synthetic opioids on the rise• Fentanyl the most potent, dangerous • Estonia - long term reporting of serious problems, deaths • Accumulation of reports - Slovakia & Bulgaria, linked with heroin shortages• Outbreaks in Germany, Sweden
6
Sources of fentanyl(s) supply
• Illicitly manufactured fentanyls - limited to fentanyl and TMF
• Misuse of fentanyl-containing medicines, mainly transdermal patches
• Medical sources diverse -theft & diversion, overprescribing, doctor shopping, waste products.
• Internet
7
Seizures of medicinal fentanyl in last 3 years
Seizures of illicitly manufactured fentanyls in last 3 years
8
Diverse epidemiology/country situations…
• Some countries - no data • One off ‘events’ e.g. Portugal• Continuous low level noise• Outbreaks - linked with ODs and deaths - different types (prescribing, new lab)• Endemic, established problem (Estonia)
9
DRD data key to understanding the epidemiology
• Epidemic curves
• Age/gender pyramids
• Deaths by fentanyl type
• Geographical distribution
Deaths in 2011 by type of fentanyl
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6 7 8 9 10 11 12
Month
Num
ber Fentanyl
3 methylfentanyl, fentanyl3 methylfentanyl
15-19
20-24
25-29
30-34
35-39
40-44
50-54
60-64
-15 -10 -5 0 5 10 15 20 25 30 35
Ag
e ba
nd
Number of deaths
Female
Male
40
1 death
35
30
25
20 ? ? ? ?
15
10
5
12012201120102009
Num
ber of cas
es
2008200720062005
0
4
8
12
16
20
1 2 3 4 5 6 7 8 9 10 11 12
Months
Num
bers
of c
ases
ViljandiTallinn
Sillamäe
Narva
Lääne-Viru countyKohtla-Järve
Jõhvi
Ida-Viru countyHarjumaa
10
Deaths related to fentanyl – different epidemic curves
40
1 death
35
30
25
20 ? ? ? ?
15
10
5
12012201120102009
Num
ber o
f cas
es
2008200720062005
109 1 death87654
321
Source Special register. Communication Head of NFP38 cases in 2011, 21 cases in 2010 - tbc
201120102009
Num
ber
of c
ases
20082007
1 death
181716151413121110
987654
321
Progressive improvement in screening for fentanyl2006-08: 28% of DRD cases screened and Source:Kipke Poster 2011 and communication2009-10: 65% of DRD cases screened
Num
ber
of c
ases
2008200720062005200420032002 201120102009
1/4 of all DRD screnned. 5% positive
2/3 of all DRD screnned. 11% positive
Source 2011 Police data
1 death4
321
Source:Np-SAD J. Corkery communication
2001 2011201020092008200720062005200420032002
Estonia (650)Sweden (?59)
Germany (160)UK (50)
11
United Kingdom
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
>=65
-15 -10 -5 0 5 10 15 20 25 30 35
Age
ban
d
Number of deaths reported
Female
Male
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
>=65
-15 -10 -5 0 5 10 15 20 25 30 35
Age
ban
d
Number of deaths reported
Female
Male
15-19
20-24
25-29
30-34
35-39
40-44
50-54
60-64
-15 -10 -5 0 5 10 15 20 25 30 35
Ag
e ba
nd
Number of deaths
Female
Male
Germany
Estonia
12
Estonia – share of fentanyl / 3MF Deaths in 2011 by type of fentanyl
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6 7 8 9 10 11 12
Month
Num
ber Fentanyl
3 methylfentanyl, fentanyl
3 methylfentanyl
13
On going risks & considerations
• Threat from continued heroin shortages?
• Role of pharmaceutical industry in promotion of patches?
• Importance of not hindering appropriate medical pain management
• Economic crisis - palliative care increasingly likely to be outside hospital settings
• Environmental health risk - need for safe waste disposal
14
Fentanyl a microcosm of complex modern day drug market
• Symptomatic of Europe’s growing synthetic opioid misuse problem
• Illicit component
• Misuse/diversion of medicines
• Designer drug, internet availability?
• …and environmental health implications
15
Fentanyls 2013 update …
• Multiple reports of fentanyls (ODs & seizures) from Canada, US, Australia, EU..
• Fentanyls emerging as NPS e.g. Carfentanyl- EWS alert Feb 2013 - 70g seized in Latvia
(not under international control)
• Carfentanyl is 4000x more potent than morphine
16
Fentanyls DRD updates …
We invite and welcome comments from experts on study and recent data
17
Update 2013 reports
0
5
10
15
20
25
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
40
1 death
35
30
25
20 ? ? ? ?
Num
ber
of c
ases
15
10
5
12005 2006 2007 2008 2009 2010 2011 2012
0
10
20
30
40
50
Sweden: Toxicological analyses at the National Board of Forensic Medicine: positive for tramadol
UK: np-SAD data
Estonia