Fentanyl: trend-spotting overview and focus on deaths. Jane Mounteney EMCDDA

Transcription

1 Fentanyl: trend-spotting overview and focus on deaths Jane Mounteney EMCDDA

2 Trendspotter - concept In depth information gathering On subject of concern, uncertainty One off and ad hoc Rapid reporting 2

3 Trendspotter methods Multi source, multi-method, multi-disciplinary, triangulation: Literature review Routine data collection Electronic survey MEETING Expert presentations Work groups Analysis 3

4 2012 Fentanyl trendspotter study Aim To 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 4

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 5

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 6

7 Seizures of medicinal fentanyl in last 3 years Seizures of illicitly manufactured fentanyls in last 3 years 7

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) 8

9 DRD data key to understanding the epidemiology 40 1 death Epidemic curves Number of cases 25 20???? Age/gender pyramids Age band Female Male Deaths by fentanyl type Number of deaths Deaths in 2011 by type of fentanyl Number Fentanyl 3 methylfentanyl, fentanyl 3 methylfentanyl Geographical distribution Month 16 Numbers of cases 12 8 Viljandi Tallinn Sillamäe Narva Lääne-Viru county Kohtla-Järve Jõhvi Ida-Viru county Harjumaa Months 9

10 Deaths related to fentanyl different epidemic curves 40 Number of cases death 20???? 15 5 Estonia (650) Number of cases 9 1 death Sweden (?59) death Source 2011 Police data Source Special register. Communication Head of NFP 38 cases in 2011, 21 cases in 20 - tbc N u m b e r o f c a s e s Germany (160) 1/4 of all DRD screnned. 5% positive 2/3 of all DRD screnned. 11% positive Progressive improvement in screening for fentanyl : 28% of DRD cases screened and Source:Kipke Poster 2011 and communication 2009-: 65% of DRD cases screened UK (50) 1 death Source:Np-SAD J. Corkery communication

11 United Kingdom A g e b an d >= Female Male Number of deaths reported Age band Germany >= Female Male Age band Estonia Number of deaths reported Female Male Number of deaths 11

12 Estonia share of fentanyl / 3MF Deaths in 2011 by type of fentanyl Number 8 Fentanyl 3 methylfentanyl, fentanyl 3 methylfentanyl Month 12

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 13

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 14

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 g seized in Latvia (not under international control) Carfentanyl is 4000x more potent than morphine 15

16 Fentanyls DRD updates We invite and welcome comments from experts on study and recent data 16

17 Update 2013 reports Estonia 40 1 death 35 Sweden: Toxicological analyses at the National Board of Forensic Medicine: positive for tramadol Number of cases 20???? UK: np-sad data