In 2021, more than 100,000 people in the United States died of drug overdoses, and the CDC says fentanyl was probably involved in over half of those deaths. Among Americans aged 18 to 45, fentanyl-related overdoses killed 41,587 people that year. COVID-19 killed a bit more than half that number in the same age range.
Three waves, then a fourth
Researchers at Stanford, working with colleagues at Harvard and the University of Toronto, mapped the opioid crisis as three distinct waves. Their study, published in JAMA in February 2019, used U.S. Census Bureau and National Center for Health Statistics data. The first wave tracked the heavy marketing of prescription painkillers from the 1990s to about 2010. The second, from 2010 until the study, was driven by fatal heroin overdoses. The third, still running at the time, came from synthetic opioids such as fentanyl and tramadol.
The crisis had by then killed more than 350,000 Americans since 1999. Opioid deaths nationwide jumped fourfold in 20 years, and the median age at death was 39.8 for men and 43.5 for women.
Mathew Kiang, the lead author and a research fellow at Stanford’s Center for Population Health Sciences, named the culprit when NBC News asked: “Heroin.” More precisely, he meant heroin laced with fentanyl, which runs about 25 to 50 times stronger than the straight drug. Dealers often do not know what they are selling. “People aren’t aware their drugs are laced and more potent than they expected, putting them at higher risk of an overdose,” Kiang said in a press release.
By 2022, some experts were describing a fourth wave. The earlier ones were defined by deaths from a specific drug. In this one, fentanyl turns up in autopsy reports alongside methamphetamine, cocaine and heroin. Why more users are taking it in combination remains unclear to experts.
Who is dying, and where
The JAMA authors wrote that opioid deaths, long pictured as a rural, low-income problem in Appalachian or midwestern states, had “spread rapidly,” particularly in the East. The highest death rates were in eight states, among them Connecticut, Illinois, Massachusetts and Maryland. In the District of Columbia, where nearly half the residents are Black, the mortality rate tripled every year since 2013. In Florida and Pennsylvania, deaths doubled every two years.
The first wave had barely touched Black Americans, because opioid prescription rates in the Black population were much lower than in the white population. That changed with heroin and fentanyl, and the authors noted “considerable increases in opioid-related mortality observed in the black population.”
Fentanyl is up to 50 times more potent than heroin and up to 100 times more potent than morphine, and 2 milligrams can be enough for a fatal overdose. Counterfeit pills sold as Percocet or OxyContin are likely to contain it. It is cheap to make, so distributors mix it into other products to raise their margins.
Kiang’s prescription was blunt. “Treating opioid use disorder should be our top priority to curb the problem,” he said. He added that overdose-reversing drugs “should be easily accessible and widely available.”
Sources
- How Fentanyl is Shaping the Opioid Epidemic in 2022: Statistics, Information, and Resources
- New Study Shows Opioids Are Claiming More African-American Lives as Deadly Epidemic Spreads Across the Country
