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In one cluster of cases occurring in Fresno, Calif., in January of this year, four people were brought to local emergency rooms.
Two of the incapacitated cocaine users died from their inadvertent fentanyl overdose, local doctors say.
Another outbreak - this time killing one person and sickening 14 more -- occurred in nearby Chico, Calif., at about the same time.
In all cases, victims "reported thinking they were snorting cocaine," said a team led by Dr. Patil Armenian, of the University of California, San Francisco, in Fresno. Instead, they had ingested cocaine laced with fentanyl, a synthetic opioid.
Other outbreaks linked to fentanyl-tainted cocaine have occurred recently in New Haven, Conn., Philadelphia and British Columbia, Canada, Armenian's team reported.
Overall, "death rates involving cocaine increased by approximately one-third during 2016-2017," the researchers added.
One emergency medicine physician wasn't surprised by those numbers.
"Fentanyl is a powerful synthetic opioid, 50 to 100 times more potent than morphine," noted Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. "It may lead to death by respiratory depression, especially in individuals who are 'opioid-naive' and consequently have not developed tolerance."
Fentanyl may also be making its way into another recreational drug, methamphetamine, Glatter said.
In fact, "in a recent study of one million randomly selected urine drug test results from medical practices in the U.S., there was a significant increase between 2013 and 2018 in the rate of tests positive for non-prescribed fentanyl among the cocaine-positive samples (from 0.9% to 17.6%) and methamphetamine-positive samples (from 0.9% to 7.9%)," Glatter noted.
In the Fresno outbreak, three people who said they'd snorted cocaine showed up on Jan. 7 at a local emergency department. One was already in cardiac arrest and was pronounced brain-dead three days later; the other two were repeatedly given the opioid overdose antidote naloxone and survived.
On Jan. 8, a fourth victim was found in cardiac arrest when emergency medical services arrived; she died at the scene.
In all cases, lab tests revealed the presence of fentanyl in the blood and/or urine. Later in January, a "federal grand jury returned a two-count indictment … against Darnell Pearson, 40, of Fresno, charging him with distribution of fentanyl resulting in death," according to a U.S. Drug Enforcement Administration news release.
Dr. Harshal Kirane directs addiction treatment and research at Wellbridge in Calverton, N.Y. Looking over the new report, he said that in some regions, synthetic opioids like fentanyl are "a latent adulterant that become evident only after it is too late."
But it's tough to know where these outbreaks will pop up, so there's "a persistent yet unpredictable risk for all communities," Kirane said.
In the Fresno cases, health care staff worked in conjunction with local law enforcement and the media to get the word out about the adulterated cocaine. Ordering lab tests for fentanyl in suspicious cases is also important, Kirane said, and "these tools can also be put in the hands of the public, by way of fentanyl test strips," to help prevent fatal overdoses.
Finally, getting people the help they need to stop using drugs is crucial, Kirane added.
"Expanding access to addiction care is one of the clearly identified pathways to overdose prevention," he said.
The new report was published Aug. 9 in the Morbidity and Mortality Weekly Report, a journal of the U.S. Centers for Disease Control and Prevention.