Fentanyl-related deaths on the rise in Washington, officials say

The synthetic opioid fentanyl and other fentanyl-like drugs were involved in the deaths of at least 70 people in the state last year, according to reports released by the agencies Wednesday.

Spokane County accounted for 6 of those deaths, giving it a fatal overdose rate of 1.2 per 100,000 people. The majority of the cases – 22 – took place in King County.

In 2015, there were 28 lab-confirmed fentanyl deaths in Washington, according to health officials. But the testing methods used in 2016 were different. Had last year’s methods been used in 2015, the number of fatal fentanyl overdoses would’ve been 53.

That increase was not as sharp as observed in some East Coast states, according to the Washington Department of Health.

Massachusetts, for instance, reported that fentanyl was involved in about three-quarters of its 1,465 confirmed opioid-overdose deaths last year.

Local researcher Caleb Banta-Green, of the UW’s Alcohol and Drug Abuse Institute, said “we’re not being hit as hard” because of differences between Washington and other states in their illicit drug markets.

At a news conference Wednesday, Banta-Green, Dr. Kathy Lofy, of DOH and Dr. Jeff Duchin, of Public Health-Seattle & King County Health, said they wanted to call attention to an emerging problem with the dangerously powerful fentanyl. It accounted for about 10 percent of all opiate overdose deaths in the state last year, Lofy said.

Fentanyl is a fast-acting synthetic opioid that is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin.

An overdose can have “an incredibly rapid onset,” Banta-Green said, causing breathing problems within seconds of injecting. Records showed that some users died with a syringe in the arm, he said.

Fentanyl compounds bought on the street or on the internet may have unpredictable levels of potency, Banta-Green said, making it hard to use a known or consistent amount, or even to know what drug you are taking.

The illegally made versions can chemically mimic the pharmaceutical drug. But they are typically sold as a powder or a pill, forms not available by prescription. Pharmaceutical fentanyl is typically available only at hospitals for surgeries and occasionally prescribed as a transdermal patch or a lollipop form to treat patients’ severe pain, according to state officials.

Of the 70 deaths last year, 41 were in King, Pierce, Snohomish and Spokane counties. Banta-Green analyzed medical examiners’ data from those four counties, where more details were available than in other counties.

“Our review showed that most overdoses involved fentanyl whose source is illicit or unknown,” Banta-Green said. “Fentanyl-related drugs are present in a substantial minority of cases, and pharmaceutical fentanyl in a small proportion of cases.”

The source and form of those non-pharmaceutical drugs are hard to determine, he said, but appear to be often purchased on the street or online, and often in the form of a powder or pill that looks like a pharmaceutical opioid or benzodiazepine.

Two-thirds of the fatal fentanyl overdoses in Washington last year killed men. The median age of the 70 people killed by the drug in the state was 38 years old.

“Unlike in the eastern U.S., where white powder heroin is often mixed with fentanyl, the majority of the fentanyl-related overdose deaths in Washington State in 2016 did not involve heroin,” said a DOH report.

Preliminary analysis of 2016 statewide data shows there were 680 opioid-related overdose deaths in Washington. During the past few years, about 700 opioid-related overdose deaths have occurred each year in Washington.

State officials recommended the following for people who use opioids and for users’ friends and family:

If anyone you know uses any kind of opioid for any reason, you should know how to recognize and intervene in an overdose. See stopoverdose.org to learn more.

Don’t use drugs alone.

If you witness an overdose involving opioids, call 911, do mouth-to-mouth rescue breathing, and use naloxone, a prescription drug which can stop an overdose in progress. Naxolone can be found at these locations and at Walgreens, Safeway and Albertson’s pharmacies in Washington.

The best long-term overdose prevention for opioid use is treatment with methadone or buprenorphine, which support long-term recovery and reduce overdose fatality rates by 50 percent. Contact the Washington Recovery Help Line (866-789-1511) to learn more about opioid-use disorder and treatment options.

Duchin said safe-injection sites could be helpful in reducing fentanyl deaths. A task force called for two sites in King County. Those sites and timelines for developing them have not been determined, Duchin said.

“These sites are part of a larger strategy expanding access to treatment,” Duchin said. The sites would not screen the drugs being injected, so they could serve fentanyl users.

The sites could “be a very effective way” to reduce overdoses, he said. “We really do need to use every tool we have.”