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Health Advisory: Increased Deaths Involving Fentanyl and Fentanyl Analogs

Published: August 02, 2018

Local Situation Update

In Sonoma County, suspected accidental fentanyl related deaths have increased (12 in 2018 as of 7/31/18, 5 in 2017, and 3 in 2016). In California, fentanyl deaths increased from 2016 to 2017 by 57%. In 2017, 373 fentanyl deaths and 1,882 opioid overdose deaths were reported in California.

Actions Requested

  • Warn patients with a history of substance abuse about the risk of purchasing street drugs at this time.
  • Prescribe naloxone and promote harm-reduction strategies, including fentanyl testing strips, to people who use drugs and their networks.
  • Consider multiple doses of naloxone  -Administration of multiple dosages of naloxone may be required due to fentanyl and fentanyl analogs’ increased potency relative to other opioids.
  • Prolonged dosing of naloxone may be necessary in emergency departments due to a delayed toxicity that has been reported in some cases of orally-ingested counterfeit pills laced with fentanyl or fentanyl analogs.
  • Emergency departments should consider post-overdose protocols, including prescription of naloxone and case management services or peer navigation programs to assist with treatment of substance use disorders.
  • Test for fentanyl when ordering drug screening on cases of suspected overdose.
  • Discuss treatment options of substance use disorders, including Medication-Assisted Treatment (MAT).
  • Be aware of the high risk of overdose for people recently released from correctional facilities due to reduced opioid tolerance.
  • First responders should use extreme caution when handling suspected illicitly manufactured fentanyl, white powders, and unknown substances. For further guidance, refer to new CDC recommendations for at risk workers ( and the White House National Security Council “Fentanyl Safety Recommendations for First Responders” (PDF)
  • Learn about and adhere to best practices for pain management and safe opioid prescribing For further guidance go to Sonoma County Health Action’s Pain Management and Safe Opioid Prescribing page:

Background and National Situation Update

Fentanyl is a colorless and odorless substance that cannot be detected without testing. In 2016, synthetic opioids became the most common type of opioid involved in opioid overdose deaths. Between 2015 and 2016, the rate of synthetic opioid overdose deaths in the U.S. rose from 3.1 to 6.2 deaths per 100,000. The U.S. drug market (supply, distribution, and potency) of illicitly manufactured fentanyl and fentanyl analogs is continuously evolving. The Drug Enforcement Administration’s (DEA) National Forensic Laboratory Information System (NFLIS) estimated that systematically collected drug submissions testing positive for fentanyl more than doubled from 2015 to 2016, rising from 14,440 to 34,119. In the first half of 2017, this trend continued with an estimated 25,460 reports. In addition, there has been a recent increase in the fentanyl analogs and other synthetic illicit opioids reports from state and local forensic laboratories. 

Number of drug submissions from state and local forensic laboratories testing positive for fentanyl analogs and U-47700 in NFLIS in 2016 and during January–June 2017:

Fentanyl analog/synthetic opiod 2016* January–June 2017^
Furanylfentanyl2,273 3,322
3-methylfentanyl427 432
Acrylfentanyl26 1,508
U-47700533 1,087

*NFLIS Brief: Fentanyl and Fentanyl-Related Substances Reported in NFLIS, 2015–2016 & NFLIS 2016 Annual Report for U-47700.
^NFLIS 2017 Midyear Report. These data are preliminary, and may change in the Annual Report for 2017.