520 Emerging Novel Drugs in Wisconsin at Autopsy

Introduction/Objective New designer street drugs have been detected in Wisconsin (WI) postmortem toxicologic analyses. Methods/Case Report To better characterize what were the most common novel drugs seen at autopsy, common drug combinations, and identify other potential abused drugs in WI, we searched our electronic EPIC autopsy database for a 7-year span (i.e. 2017-2024) using key terms ‘acetyl fentanyl,’ ‘acryl fentanyl,’ ‘bromazolam,’ ‘brorphine,’ ‘carfentanil,’ ‘disalkylgidazepam,’ ‘flubromazepam,’ ‘fluorofentanyl,’ ‘khat,’ ‘kratom,’ ‘nitazene,’ ‘medetomidine,’ ‘piperazines,’ ‘tianeptine,’ ‘xylazine,’ and ‘1,1-difluoroethane.” Results Our search yielded 73 deaths involving mono- or polydrug abuse of novel drugs. Of these, 72.6% cases involved novel synthetic opioids (e.g. 8.2% nitazenes, 57.5% fentanyl analogues, and 1.4% brorphine). Nitazenes included nitazene, flunitazene, isotonitazene, metonitazene, while fentanyl analogues included fluorofentanyl, carfentanil, and acetyl fentanyl. Additionally, 19.2% cases involved xylazine, 11% cases involved novel benzodiazepines (e.g., bromazolam, flubromazepam), and 11% cases involved 1,1-difluoroethane. Fentanyl and methamphetamine toxicity was the most common drug toxicity combination (19.2%), followed by fentanyl and heroin toxicity (11%), fentanyl and cocaine toxicity (8.2%), fentanyl, cocaine, and methamphetamine toxicity (8%), fentanyl, cocaine, and heroin toxicity (1.4%), and fentanyl, heroin, and methamphetamine toxicity (1.4%). We also identified four potential drugs of misuse/abuse, including quinine (5), mitragynine (7), diphenhydramine (9), and gabapentin (11). Conclusion This study illustrates the changes in drug overdose patterns in WI since 2017.