Are Bootleg Fentanyls the New Pill Mills?

The number of deaths from prescription opioids from 2014 to 2016 were essentially unchanged, but deaths from illicit fentanyl derivatives over the same time period increased by almost 650%. Between 2010 and 2015, we know that by county, prescribed morphine daily dose equivalents (MEDD) per capita decreased by about 50% and remained stable in about 30%. We also know that during the same time span, overall opioid prescribing rates by county decreased about 50% and remained stable at 34%. Additionally, between 2010 and 2015, the average daily MEDD per prescription dropped by 72%, remained the same in 26%, and increased only by 2% per county. Heroin related deaths have skyrocketed over the last 2 years and, in certain states, up to 70% of the presumed heroin related deaths in fact are attributable to heroin laced with illicit carfentanil or similar ultrahigh-potent derivatives. The CDC has often lumped aggregated data for opioids into various reports without consideration of combined prescription related opioids that were obtained illegally and used in combination with illicit opioids plus or minus other sedative hypnotics including alcohol. This data has unfortunately mushroomed into lay press (false) claims that prescription opioids are synonymous with the devil. This session will provide an overview of the data, separate fact from fiction, and provide a comprehensive overview of illicit fentanyl derivatives, relative potencies, and dangers. Participants will gather the necessary information to intelligently separate alternative facts from the real facts as they relate to opioid related deaths. (Recorded at PAINWeek 2018)