Vol.:(0123456789) 1 3 Forensic Science, Medicine and Pathology https://doi.org/10.1007/s12024-020-00321-5 ORIGINAL ARTICLE An investigation of demographic and drug‑use patterns in fentanyl and carfentanil deaths in Ontario Filbert Yung 1  · Jayantha Herath 2 Accepted: 24 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract The opioid epidemic in Ontario has seen opioid-related deaths double in recent years, from 676 deaths in 2014 to 1,474 in 2018, with an overwhelming prevalence of fentanyl and fentanyl-analogues, such as carfentanil. The presence of drug paraphernalia and a history of drug-use is often a strong indicator of a drug-related death, indicating a need for toxicologi- cal analysis. Demographic and drug-related patterns associated with opioid deaths in Ontario from June 2017 to December 2018 (n = 2403) were investigated using data collected from the Coroner’s Opioid Investigative Aid (OIA). This work aims to provide insight on how the opioid epidemic affects certain demographics to aid investigators conduct targeted analyses and help public health officials identify vulnerable communities. Chi-square and logistic regressions were conducted to evaluate if age and sex were predictors for the presence of drug paraphernalia, and if drug paraphernalia, sex, age, or history of drug use were associated with causes of deaths (COD). Chi-square analysis revealed that sex (p < 0.001), the presence of drug-use history (p < 0.001), and the presence of drug paraphernalia at the scene of death (p < 0.001) were significantly associated with CODs. Sex was also significantly associated with the presence of drug paraphernalia (p < 0.001). Logistic regression analysis indicated that age (p < 0.001) influenced the probability of opioid-related deaths. Probability models relating age to various opioid-related CODs were also generated. These results demonstrated that fentanyl-related deaths are more associated with males, younger individuals, individuals with a history or drug-use, and the presence of drug paraphernalia. Keywords Forensic science · Forensic pathology · Carfentanil · Demographic · Fentanyl · Ontario Introduction The opioid crisis is a public health epidemic, most prevalent in the US and Canada, that is characterized by significant increases in opioid-related accidental deaths. It is driven by multiple factors, including the over prescription of opioids and the emergence of synthetic alternatives such as fentanyl [1]. Demographic and drug-related patterns associated with opioid deaths, specifically fentanyl, fentanyl analogues and carfentanil, in Ontario from June 2017 to December 2018 were investigated by analyzing investigative data collected from the Coroner’s Opioid Investigative Aid (OIA) by the Office of the Chief Coroner for Ontario and Ontario Forensic Pathology Service (OCC/OFPS). This information aims to identify trends in fentanyl and carfentanil-related deaths in Ontario, which may be used to aid forensic investigators in identifying key pieces of evidence that may indicate a need for further investigation and help public health officials identify communities vulnerable to opioid-related deaths. Fentanyl is a synthetic opioid pain-reliever commonly prescribed in the form of a gel patch for pain management, particularly to cancer patients who have developed tolerance to continuous opioid use [2]. Initially, it was often illicitly sold and abused by extracting the drug from patches in the form of a gel. More recently, fentanyl has been synthesized in clandestine labs, often mixed with heroin, oxycodone, other stimulants, etc., and administered by injection, inges- tion, or absorption through mucosal surfaces [3, 4]. Over- doses of fentanyl, especially when taken with other drugs, may lead to respiratory depression, causing rapid loss of consciousness, comas, or even death [5, 6]. * Filbert Yung filbert.yung@mail.utoronto.ca 1 University of Toronto Mississauga, Mississauga, Canada 2 Ontario Forensic Pathology Service, University of Toronto, Toronto, Canada