Caroline Copeland is a Lecturer in Pharmaceutical Medicine at the Institute of Pharmaceutical Sciences, King’s College London, where she is the Director of The National Programme on Substance Abuse Deaths (NPSAD). NPSAD has been collecting information about drug-related deaths from across the UK since 1997. In-depth information regarding demographics of decedents and toxicology reports is analysed and reported to Public Health England, the Home Office’s independent Advisory Council for the Misuse of Drugs, and local authority drug death forums, to inform and guide drug policy. Caroline also performs independent research using this data, most recently publishing on the extent of fentanyl-related deaths in England.
A deadly trend in Fentanyl fatalities (England 1998-2017)
Aim: To identify trends in drug-related deaths associated with fentanyl and its derivatives, including novel variants, in England, 1998-2017.
Methods: Case reports from the National Programme on Substance Abuse Deaths (NPSAD) where a pharmaceutical fentanyl or non-pharmaceutical fentanyl derivative (NPFD) was found at post-mortem and/or implicated in the death were extracted for analysis.
Results: NPSAD has received case reports detailing 298 deaths in England from 1998-2017 where a fentanyl was found at post-mortem and/or implicated in the death. Hospital administered fentanyl is ‘very safe’, whereas pharmaceutical fentanyls in the community, procured either legitimately via prescription or illegitimately, carry high risk of unintentional death. Deaths involving NPFDs, which possess extreme potencies in comparison to morphine, have drastically risen over the past three years, and correlate with an increasing number of available compounds. Males, and those with existing opioid abuse disorders are particularly susceptible to death related to NPFD intake. These data have been reported to the Home Office’s independent Advisory Council on the Misuse of Drugs.
Conclusions: The increasing availability of both pharmaceutical fentanyls and NPFDs represents a serious risk to public health in England, which is also reflected at the international level. Of particular concern is the extreme potencies possessed by the NPFDs, with US courts currently considering harsher legal penalties based upon synthetic opioid potencies. However, as the ‘Iron Law of Prohibition’, with the doctrine ‘the harder the enforcement, the harder the drugs’, unfortunately appears applicable to NPFDs, will this only further accelerate the ‘opioid crisis’?