The Synthetic Opioid Surge in the United States: Insights from Mortality and Seizure Data

Abstract

T he drug overdose crisis in the United States was initiated by prescription opioids nearly two decades ago (Kolodny et al., 2015). Since 2014, increases in overdose deaths have been driven largely by exposure to potent synthetic opioids, such as fentanyl, its analogs, or other novel synthetic opioids.1 In 2017, there were more than 70,000 drug-involved overdoses, of which some 47,000 involved opioids (Scholl et al., 2019). Synthetic opioids, principally fentanyl (Hedegaard et al., 2018), were reported in more than 31,000 fatal overdoses, or two-thirds of all opioid-involved deaths, in 2018 (Ahmad et al., 2019). Starting in late 2013, illicitly manufactured synthetic opioids entered some markets as adulterants in heroin; they were also pressed into counterfeit tablets and sold on the street as prescription medications (Drug Enforcement Administration [DEA], 2018; Gladden, Martinez, and Seth, 2016). In less than six years, the number of fatal overdoses involving synthetic opioids in the United States has risen tenfold, surpassing drug overdoses for heroin or prescription opioids by a factor of two. Perhaps even more troubling is the possible diffusion of synthetic opioids into nonopioid markets (DEA, 2018; Jones, Einstein, and Compton, 2018). Cause of death data analyzed in this report show that in 2017 more than half of cocaine and one-quarter of psychostimulant overdose deaths also mentioned synthetic opioids.2 C O R P O R A T I O N