The field of illegally manufactured fentanyls (IMFs) continue to evolve in interesting and unexpected ways, particularly geographically. This article demonstrates that despite the encouraging average drop in overdose deaths from 2022-2023 (ranging from 2.8-7.8%) these deaths were actually increasing significantly in the western US (by 33.9%). It seems that our corner of the country's relative respite compared to other areas is likely over.
The article highlights carfentanil, a potent opioid designed for large animals in veterinary use, which has appeared in opioid-related deaths 7x more commonly in 2024 compared to 2023. In reality, this particularly fentanyl is a drop in the bucket compared to deaths caused by just fentanyl itself--however it remains an interesting trend and one likely to repeat itself as fentanyl derivatives continue to be exploited by enterprising drug makers.
Clinical management will remain the same: maintain a low threshold for large doses of naloxone for reversal if needed. Its half-life is longer than that of fentanyl's, so as in all opioid overdoses, signs of renarcotization should prompt admission for observation.