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DPH research center updates: fentanyl drives opioid mortality; stimulant harms require broader prevention approach
Summary
Researchers at the Department of Public Health’s Center on Substance Use and Health briefed commissioners on ongoing clinical trials, the dominant role of fentanyl in opioid deaths, and a push to treat stimulant‑related harms more like chronic disease, while federal research funding uncertainty threatens program capacity.
Dr. Coffin, of the Center on Substance Use and Health within DPH’s Population Health Division, presented the center’s recent studies and findings and described how drug‑supply changes are altering overdose patterns. The center’s work spans clinical trials, epidemiology and academic detailing with local providers.
“Fentanyl… is responsible basically for 95 percent of our opioid deaths,” Dr. Coffin told the commission, summarizing the center’s analysis of opioid fatalities. He said fentanyl’s potency has reduced the ability of behavioral interventions to lower opioid overdose risk in isolation, and that medications for opioid use disorder — including buprenorphine and methadone — remain essential.
Coffin reviewed stimulant research and clinical trials under way or concluding at the center, including phase 1 mirtazapine testing for methamphetamine use disorder, a trial of ketamine‑assisted psychotherapy for methamphetamine use disorder (CARE), and studies of extended‑release naltrexone to prevent opioid overdose among people who do not intend to use opioids. He described contingency management as first‑line treatment for stimulant use disorder and said a mix of medications — buprenorphine, mirtazapine and naltrexone in some cases — are being studied for broader use.
Coffin urged a reframing of some stimulant‑related deaths: many fatalities involving stimulants without opioids resemble chronic disease deaths, the presenter said, with cardiac and other comorbidities. “Deaths that don’t involve opioids… look more like chronic disease deaths,” he said, arguing that prevention strategies for stimulant harms should include cardiovascular risk reduction and other long‑term prevention tools.
Commissioners asked about emerging synthetic opioids such as nitazenes. Coffin said nitazenes have appeared in some toxicology samples but so far are not a primary driver of the city’s crisis; their most notable harms in other regions are severe injection‑related tissue damage. He also warned that federal research funding instability has reduced center staffing from around 30 to about 15, a shrinkage that could affect upcoming trials.
Ending: Commissioners thanked the center and requested follow‑up on grant prospects and more granular demographic tracking of deaths by drug involvement.
