Last reviewed: 30 Sep 2020
Last updated: 04 Jan 2019
20 Sep 2018

CDC alerts clinicians to a 'dramatic rise' in overdose deaths from fentanyl and its analogs

New data from an enhanced surveillance program for opioid overdose deaths has prompted the Centers for Disease Control and Prevention (CDC) to alert clinicians to a 'dramatic rise' in deaths from synthetic opioids including fentanyl and its analogs.

Seven of the 10 US states involved in the CDC-funded surveillance program reported that more than half of all opioid overdose deaths tested positive for fentanyl or fentanyl analogs (e.g., 3-methylfentanyl, carfentanil) in the period July 2016 to June 2017. One factor behind the increasing availability of fentanyl and its analogs has been via the widespread adulteration of cocaine.

The CDC has advised healthcare providers that fentanyl and its analogs are potent opioids; patients being treated for an overdose may require the administration of multiple doses of naloxone. Other commentators cited by the CDC have advised that some patients exposed to long-acting or very potent opioids (e.g., fentanyl, 3-methylfentanyl, carfentanil) may need naloxone by continuous infusion.[6][7]

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See Management: treatment algorithm

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History and exam

Key diagnostic factors

  • history of opioid abuse and dependence
  • miosis
  • bradypnea
  • altered mental status
  • dramatic response to naloxone

Other diagnostic factors

  • fresh needle marks
  • drug paraphernalia nearby
  • decreased gastrointestinal motility
  • old track marks on arms and legs
  • pulmonary rales
  • frothy pink sputum
  • seizures
  • dysrhythmias

Risk factors

  • opioid abuse and dependence
  • recent abstinence in chronic users
  • chronic pain

Diagnostic investigations

1st investigations to order

  • therapeutic trial of naloxone
  • Electrocardiogram (ECG)
More 1st investigations to order

Investigations to consider

  • chest x-ray
  • abdominal x-ray
  • abdominal CT scan
  • opioid urine screen
  • gas chromatography/ mass spectrometry
More investigations to consider

Treatment algorithm


Consultant Physician and Clinical Toxicologist

National Poisons Information Service (Newcastle)




RT declares that he has no competing interests.

Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this monograph. DO declares that he has no competing interests.

Peer reviewersVIEW ALL


Gynecologic Oncologist

Northwest Cancer Specialists

Rose Quarter Cancer Center




WW declares that he has no competing interests.


Joseph Epstein Centre for Emergency Medicine Research

Western Health Sunshine Hospital

St Albans



AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.

Assistant Professor

Johns Hopkins University




AS declares that he has no competing interests.

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