Characterizing Fentanyl Outbreaks

Characterizing Fentanyl Outbreaks: Ethnographic and Forensic Perspectives

Submitted in response to NIDA PAR-16-055, Research Area 1 (Responses to sudden and severe emerging drug issues), this time-sensitive R21 application builds on interdisciplinary collaboration between researchers at the Center for Interventions, Treatment and Additions Research and the Department of Chemistry at Wright State University, and longstanding partnership with the Montgomery County Coroner’s Office/Miami Valley Regional Crime Lab (MCCO/MVRC) and Public Health-Dayton & Montgomery County. The overall purpose of the proposed study is to characterize NPF outbreaks through the integration of ethnographic/qualitative assessment of active user knowledge and experiences of NPF use, and the results from forensic analyses conducted by the postmortem toxicology and crime laboratories at MCCO/MVRC.

The study will be conducted in the Dayton, Ohio, Area (Montgomery County) that has been recognized as a “new frontier” of the U.S. heroin epidemic and the place of one of the largest NPF outbreaks in the country. Ohio had the greatest numbers of NPF drug seizures in the U.S (1,245 in Ohio in 2014, compared to 4,585 for the country as a whole), and in 2014 there were over 500 overdose deaths in Ohio related to NPF use. The Dayton, Ohio, area has experienced some of the highest rates of opioid-related unintentional drug overdose mortality in the state, and reported very high numbers of NPF-related deaths. Between November 2013 and November 2015, there were over 200 overdose deaths linked to NPF in Montgomery County alone. The Specific Aims of the study are to:

1. Provide an in-depth understanding of active user knowledge and experiences related to the availability and use of NPF products.
2. Analyze forensic data to characterize toxicological features and epidemiological trends of NPF use.
3. Compare, contrast, and integrate ethnographic and forensic data on outbreaks of NPF product use.

A major strength of the study is our longstanding partnership with the MCCO/MVRC and Public Health Dayton and Montgomery County (PHDMC) through our conduct of the Montgomery County Poisoning Death review since 2010.¹⁹Importantly, PHDMC has agreed to provide office space for the conduct of qualitative interviews without charge. The proposed study meets the criteria for time sensitive R21 because it responds to very large and severe emerging NPF use outbreaks that require immediate intervention and policy responses. The study is highly significant because it will provide new information about toxicological features of the outbreak and user knowledge, attitudes and behaviors related to NPF use. The study will also provide a better understanding of how two different data streams could complement and enhance each other to inform drug abuse epidemiologic research. The key innovation is the interdisciplinary collaboration integrating ethnographic/qualitative and forensic perspectives. The findings are likely to provide preliminary key indicators for the design of public health interventions and policy.

This study is funded by the NIH/NIDA Grant No. 1R21DA042757

Principal Investigators: Raminta Daniulaityte

Co-Investigators: Matthew Juhascik (Montgomery County Coroner’s Office); Ioana Sizemore (Department of Chemistry)

Graduate Research Assistants: Kraig Strayer (Chemistry); Mussa Zatreh (Public Health)

Publications:

Lokala, U., Lamy, F., Sheth, A., Nahhas, R., Roden, J., Carlson, R., Yadav, S. 2018. Global trends, local harms: availability of fentanyl-type drugs on the dark web and accidental overdoses in Ohio. Computational and Mathematical Organization Theory. October.

Daniulaityte R, Juhascik MP, Strayer KE, Sizemore, I., Harshbarger, K.E., Antonides, H.M., Carlson, R.G. Overdose Deaths Related to Fentanyl and Its Analogs — Ohio, January–February 2017. Morbidity and Mortality Weekly Report 2017; 66:904–908. DOI: http://dx.doi.org/10.15585/mmwr.mm6634a

Strayer, K., Antonides, H., Juhasick, M., Daniulaityte, R., Sizemore, I. A LC-MS/MS-based method for the multiplex detection of 24 fentanyl analogs and metabolites in whole blood at sub ng mL-1 concentrations. ACS Omega, 2018, 3-514-523.https://pubs.acs.org/doi/full/10.1021/acsomega.7b01536

Daniulaityte, R., Juhascik, M.P., Strayer, K.E., Sizemore, I.E., Zatreh, M., Nahhas, R.W., Harshbarger, K.E., Antonides, H.M., Martins, S.M., Carlson R.G. Trends in Fentanyl and Fentanyl Analogue-Related Overdose Deaths Montgomery County, Ohio, 2015-2017.” Drug and Alcohol Dependence, 2019, 198, 116-120.https://www.sciencedirect.com/science/article/pii/S0376871619300778