Health Alert Network
Montana Health Alert Network
June 6, 2022
Increased Fentanyl-related Fatalities in Montana
Fentanyl, a synthetic and short-acting opioid analgesic, is 50-100 times more potent than morphine and approved for
managing acute or chronic pain associated with advanced cancer.1 Although pharmaceutical fentanyl can be diverted
for misuse, most cases of fentanyl-related morbidity and mortality have been linked to illicitly manufactured fentanyl
and fentanyl analogs, collectively referred to as non-pharmaceutical fentanyl (NPF).2 NPF is sold via illicit drug markets
for its heroin-like effect and often mixed with heroin and/or cocaine as a combination product—with or without the
user’s knowledge—to increase its euphoric effects. While NPF-related overdoses can be reversed with naloxone, a
higher dose or multiple number of doses per overdose event may be required to revive a patient due to the high
potency of NPF. 3,4
The Montana Department of Public Health and Human Services (DPHHS) in conjunction with local law enforcement
have identified a sharp increase in fatal overdoses across the state in the last two weeks. In the period from
5/22/2022 and 6/1/2022 there have been at least 8 fatal overdoses, likely due to fentanyl.
DPHHS data shows that Emergency Medical Services (EMS) responded to five calls related to overdose where the
individual was pronounced dead on scene or upon arrival to the emergency department. Further data from law
enforcement report three unattended overdose deaths.
• Decedents were between the ages of 24 to 60 years old; three-quarters were male
• Several decedents had a known history of opioid use disorder
• Blue M30 pills (likely illicitly manufactured fentanyl pressed into counterfeit pills) and other drug
paraphernalia were located nearby several of the decedents
• Deaths occurred in Cascade, Custer, Gallatin, Lake, Lewis and Clark, and Yellowstone County
Additional information from law enforcement shows that fentanyl seizures across the state has increased dramatically;
more fentanyl was seized in the first 3 months of 2022 than in the previous four years combined.
Local Health Departments
1. Raise awareness among key partners and stakeholders to the widening profile of those at risk
for fentanyl overdose, which increasingly includes persons misusing diverted prescribed oral
pain and sedative medications.
2. Develop public health messaging about fentanyl, including fentanyl-laced counterfeit pills and fentanyl related compounds that emphasizes the toxicity and potential lethality of the drug versus its high “potency.”
The messaging should include warnings of the highly variable content of fentanyl present in illicit products,
which further elevates risk of overdose.5,6
3. Continue to encourage eligible recipients, including individuals at-risk for opioid-related overdose and family
members and friends of those at-risk, to carry naloxone. Educate eligible recipients on the importance of
activating EMS during an overdose event as the naloxone reversal effects may be temporary and overdose related respiratory depression may return.
4. Encourage those who are at risk of an overdose to not use alone and preferably with others knowledgeable
about the administration of naloxone and with a supply of naloxone on hand.
EMS and Law Enforcement
1. Be aware of the potential for increased incidence of overdose in your community related to NPF and for the
potential need for additional stocks of naloxone on hand.
2. Prioritize and expedite laboratory testing of drug samples taken from drug overdose scenes.
3. Continue to monitor individuals who have overdosed on fentanyl after receipts of bystander naloxone given
the risk for recurrent respiratory depression once the temporary naloxone effect has ended.
Expanding Naloxone Access
The State of Montana has issued a Montana Standing Order for Naloxone Opioid Antagonists that allows Montanans
to access naloxone at no cost. Naloxone is a safe medication that can reverse a suspected opioid-related overdose.
Organizations and facilities may create a Memorandum of Understanding with the State of Montana that will allow
• Order naloxone directly from the contracted pharmacy
• Distribute naloxone into the hands of those who are at risk of experiencing opioid-related drug overdose and
to a family member, friend, or other person who can assist a person who is at risk of experiencing an opioid related drug overdose
• Keep naloxone on hand for staff to administer as needed
Training on the administration of naloxone is also available at no cost.
To learn more about training and accessing free naloxone, visit Naloxone.mt.gov
Additional Information: For more information regarding opioid issues in Montana, please refer to these resources:
DPHHS Opioid Prevention Program
Drug Poisoning Deaths in Montana, 2009-2020
Montana Implementation Guide for Access to Naloxone Opioid Antagonists
Opioids Overdose Recognition and Response Guide (Pamphlet)
Montana Standing Order for Naloxone Opioid Antagonists
1. Algren D, Monteilh C, Rubin C, et al. Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July
2005-May 2006). Journal Of Medical Toxicology: Official Journal of the American College of Medical Toxicology [serial online].
March 2013; 9(1):106-115.
2. U.S. Department of Justice, Drug Enforcement Administration, DEA Investigative Reporting, January 2015
3. Centers for Disease Control and Prevention. Notes from the field: Acetyl fentanyl overdose fatalities -Rhode Island, March-May
2013. MMWR: Morbidity & Mortality Weekly Report [serial online]. August 30, 2013; 62(34):703-704.
4. Centers for Disease Control and Prevention. Recommendations for Laboratory testing for Acetyl Fentanyl and Patient Evaluation
and Treatment for Overdose for Synthetic Opioids. HAN Health Advisory. June 20, 2013.
5. Canadian Center on Substance Abuse Bulletin. Novel synthetic opioids in Counterfeit pharmaceuticals and other illicit street
drugs. June 2016. http://www.ccsa.ca/Resource%20Library/CCSACCENDU-Novel-Synthetic-OpioidsBulletin-2016-en.pdf
6. Sutter ME, Gerona R, Davis MT, et al. Fatal fentanyl: one pill can kill. Acad Emerg Med. [Epub ahead of print June 20, 2016]