Health Alert Network
Montana Health Alert Network
DPHHS HAN
Information Sheet
DATE
June 6, 2022
SUBJECT
Increased Fentanyl-related Fatalities in Montana
BACKGROUND
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
INFORMATION
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.
RECOMMENDATIONS
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.”
2
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
them to:
• 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
https://dphhs.mt.gov/opioid/index
Drug Poisoning Deaths in Montana, 2009-2020
https://dphhs.mt.gov/assets/publichealth/EMSTS/opioids/DrugPoisoningDeaths22.pdf
Montana Implementation Guide for Access to Naloxone Opioid Antagonists
https://dphhs.mt.gov/assets/publichealth/EMSTS/opioids/MontanaImplementationGuideforIncreasedNalo
xoneUpdatedMay2019.pdf
Opioids Overdose Recognition and Response Guide (Pamphlet)
https://dphhs.mt.gov/assets/publichealth/EMSTS/opioids/Naloxonebrochure.pdf
Montana Standing Order for Naloxone Opioid Antagonists
https://dphhs.mt.gov/assets/publichealth/EMSTS/opioids/MontanaStandingOrderforNaloxoneOpioidAntag
onists2022.pdf
3
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.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6234a5.htm
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.
http://stacks.cdc.gov/view/cdc/25259
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]
http://onlinelibrary.wiley.com/doi/10.1111/acem.13034/abstrac