Researchers find that synthetic opioid use is on the rise.
A report released by the Rand Corporation showed the deaths in the United States from synthetic opioids, especially fentanyl, rose more than ten-fold in five years. The analysis compiled by the nonprofit organization showed deaths in the United States involving synthetic opioids increased from approximately 3000 in 2013 to more than 30,000 in 2018 and contributed to twice as many deaths was heroin. The researchers noted this epidemic is “unlike others that have struck the nation.”
“This crisis is different because the spread of synthetic opioids is largely driven by suppliers’ decisions, not by user demand,” said lead author Bryce Pardo, PhD, associate policy researcher at Rand Corporation. “Most people who use opioids are not asking for fentanyl and would prefer to avoid exposure.”
Jill M. Williams, MD, chair of the Council on Addiction Psychiatry for the American Psychiatric Association (APA) called this an important, substantial, “and quite comprehensive” report, adding, “I think it really helps to show the scope of the issues in clear terms. A lot of this is unprecedented. Clinicians just need to be aware in terms of screening. We really need to continue to talk to patients and the public about the need for medication-assisted treatment, which is a key component of the problem of opioid-use disorder.”
The authors conclude that “(1) fentanyl and other synthetic opioids are becoming dominant in some parts of the United States and Canada, but remain less common in other parts of these countries; (2) a confluence of factors, including the dissemination of simplified and novel synthesis methods and increasing e-commerce, helps explain the surge in synthetic opioids; (3) much can be learned from other countries’ experiences with synthetic opioids; (4) supplier decisions, not user demand, drive the transition to fentanyl; (5) fentanyl’s spread is episodically fast and has ratchet-like persistence; (6) synthetic opioids drive up deaths rather than the number of users; (7) problems with synthetic opioids are likely to worsen before they improve, and states west of the Mississippi River must remain vigilant; (8) improving surveillance and monitoring is crucial; and (9) limiting policy responses to existing approaches seems unlikely to reverse this tide.”
Overdose deaths involving fentanyl remains most prevalent in Northeast and Midwest U.S., largely due to differences in drug trafficking networks and “the kinds of heroin that fentanyl was initially laced in,” according to the researchers. This means the problem is already a substantial one in this concentrated area and has room to grow into an even bigger one.
According to the report, “One of the most important – and depressing – insights in this analysis is that however bad the synthetic opioid problem is now, it is likely to get worse before it gets better…In 2017, ten states accounted for one-third of all mentions of synthetic opioid overdoses, despite making up a little more than one-tenth of the nation’s population. Conversely, almost three in ten states report synthetic opioid overdose death rates that are one-quarter of the national average of nine per 100,000. The math is simple and distressing: If the rest of the country had a synthetic opioid – involved death rate of half of New England’s in 2017, that would come to about 38,000 synthetic opioid–involved fatal overdoses.”