Nonpharmaceutical fentanyl-related deaths--multiple states, April 2005-March 2007.

On April 21, 2006, increases in overdoses were reported among illicit drug users in Camden, New Jersey, via the CDC Epidemic Information Exchange (Epi-X). This alert elicited reports of similar increases in overdoses in other parts of New Jersey, and in Maryland; Chicago, Illinois; Detroit, Michigan; and Philadelphia, Pennsylvania. The increases in Chicago and Detroit had been recognized several months earlier but attributed to heroin overdoses until fentanyl was detected in the blood or urine of some decedents. Illicitly manufactured nonpharmaceutical fentanyl (NPF), a synthetic opioid 30-50 times more potent than heroin, also was found by law enforcement personnel and medical examiner staffs at the scene of some overdoses. In May 2006, to identify NPF-related deaths in six state and local jurisdictions, CDC implemented an ad hoc case-finding and surveillance system, later managed by the Drug Enforcement Administration (DEA). This report summarizes the results of that effort, which identified 1,013 NPF-related deaths that occurred during April 4, 2005-March 28, 2007. As a result, on April 23, 2007, DEA began regulating access to N-phenethyl-4-piperidone, a chemical used to make illicit NPF. Increased public health efforts are needed to improve epidemiologic data collection on drug overdoses, enable early detection of increases in drug overdoses, educate illicit drug users regarding the risks for overdose, and help users obtain treatment for their addictions.