Medical Examiner Reports Deaths from Powerful Opioids on the Rise

The Cook County Medical Examiner’s Office has seen an increase in deaths attributed to fentanyl and fentanyl analogues, which chemical derivatives of fentanyl.

Fentanyl is an opiate that is up to 100 times more potent than morphine, which is the active component of heroin. Fentanyl analogues are typically not pharmaceutical-grade drugs like those administered by medical professionals for severe pain.Since mid-December, at least seven deaths were caused, at least in part, by furanyl fentanyl, according to toxicology tests results received this year.

Since September, there have also been at least six deaths attributed, at least in part, to acetyl fentanyl and at least one case presented with butyric fentanyl.

In all, since September, when the office began to see a sharp rise in fentanyl-related deaths, there have been at least 106 deaths attributed, at least in part, to fentanyl or fentanyl analogues. Most of those deaths – 102 of them – occurred in 2015. The data for 2016 is not a real time number, as toxicology testing can take 60-90 days.

Toxicology tests show decedents have used fentanyl alone, with heroin and with other drugs, such as cocaine. In many cases, heroin users have been supplied with heroin mixed with fentanyl, pure fentanyl, and fentanyl derivatives resulting in overdose due to respiratory depression.

“Since September we have been seeing an increase of fentanyl and fentanyl analogues,” said Dr. Peter Koin, Deputy Chief Toxicologist for the Cook County Medical Examiner’s Office. “Fentanyl and fentanyl analogues pose a great public health because people may not know they’re using a very powerful drug. In addition, we’re seeing new versions fentanyl and testing for these substances is challenging because we’ve never seen them before. It’s something brand new.”

People who have used fentanyl are also presenting to the Cook County Health and Hospital System’s John H. Stroger Jr., Hospital.

“Fentanyl and fentanyl analogues are a huge concern because fentanyl is 20 to 100 times more potent than heroin, posing a much greater risk of overdose,” said Dr. Steven Aks, emergency medicine physician and toxicologist at Stroger Hospital. “In many cases, one dose of naloxone, the heroin antidote, will revive a person who has overdosed on heroin. But we are seeing people in our emergency department who need as many as four doses as naloxone to be stabilized after ingesting fentanyl, or a heroin/fentanyl combination.”

In 2014, 20 deaths were attributed to fentanyl, according to the Medical Examiner’s Office.

However, the Cook County Medical Examiner’s Office began routinely testing for fentanyl starting in June 2015 after national trends showed a spike in fentanyl use. Previously, the office tested for fentanyl at the discretion of the pathologist. Often testing was done due to the circumstance of the case; for example, if an unknown substance was found with a decedent.

The Medical Examiner’s Office has been working closely with public health officials, local hospitals and policy-makers to help bring this emerging epidemic under control.