Lab experts cite need for collaborations on opioids

Karen Bouffard
The Detroit News

An alarming spike in deaths from fentanyl-related compounds is challenging forensic laboratories, medical examiners and law enforcement in Michigan and across the United States, experts said Monday at a national conference on synthetic opioids in Ypsilanti.

Forensic scientists with the Michigan State Police laboratories said they’ve noted an increase in fentanyl-related compounds over the past 12 months, forcing them to put new safety procedures in place to protect lab workers from toxic substances seized by law enforcement and sent there for analysis.

Among drugs analyzed by state police labs since January, more than 1,000 pills included fentanyl, a synthetic opioid 50 times more potent than heroin. Another 188 pills included fentanyl analogs, drugs made by modifying the fentanyl molecule. Carfentanil, a fentanyl derivative blamed for thousands of deaths nationwide, was present in 134 confiscated drugs.

The two-day symposium, “Synthetic Opioids and the Overdose Epidemic,” drew about 150 scientific, law enforcement and policy experts. The drugs are being developed so fast that laboratories find themselves analyzing substances they’ve never seen. The substances often include a combination of drugs and cutting agents, further confounding investigators.

“These mixtures get progressively more complicated,” said Elaine Dougherty, supervisor of the controlled substances unit with the MSP Forensic Science Division. “We’ve seen as many as five or six controlled opioids in one mixture, including sometimes more than one fetanyl analog.”

Dr. Carl Schmidt, the Wayne County medical examiner, told the group drug deaths countywide increased from 420 in 2011 to 849 in 2016. In 80 percent of those deaths, more than one drug was involved. Of the deaths in 2016, fentanyl was involved in 430, compared to 334 that involved heroin. Schmidt said he expects this year’s death total to be similar to 2016.

Schmidt said deaths from illicit drug use now exceed those caused by use of prescription opioids. As evidence, he noted a decline in the number of deaths involving acetaminophen, which is often combined with opioids in prescription medicines like Vicodin.

Schmidt said the opioid epidemic is mostly a suburban phenomenon. The average victim of an overdose death in Wayne County is a white, 42-year-old man, he said. African-Americans also are at risk, but the danger for that group is posed more by cocaine than by heroin. It’s imperative medical examiners understand the patterns of drug use, he said.

“Cocaine seems to be making a comeback,” Schmidt said, adding cocaine was present in 322 of the 849 overdose deaths in 2016.

Jayne Morrow, senior science policy adviser with the National Institute of Standards and Technology, said it is critical that forensic scientists, medical examiners and law enforcement work together to identify toxic substances.

“Because the compounds are changing so quickly, it really does look like infectious disease epidemiology,” she said. “We need a framework for syndromic surveillance for novel psychoactive substances for medical examiners, law enforcement and toxicology.”