Fentanyl Abuse Statistics

Fentanyl abuse statistics indicate it is the world’s deadliest opioid, causing nearly three quarters of all overdose deaths nationwide.

Key Findings

Related reports include Drug Abuse Statistics | Alcohol Abuse Statistics | Average Cost of Drug Rehab | Drug Overdose Death Statistics | Teenage Drug Use Statistics | Marijuana Addiction Statistics | Opioid Crisis Statistics | Prescription Drug Abuse Statistics

Fentanyl Statistics

First developed in 1959-60, Fentanyl is 100 times more potent than morphine. Valued as a “miracle drug” by pain specialists, skyrocketing overdose rates have made for more conservative usage.

• Nearly 73,000 overdose deaths (OD) involved fentanyl in 2023.
• Fentanyl OD rates are 1,750% higher than heroin ODs.
• Fentanyl ODs outpace prescription opioid ODs by 458.7%.
• In 2020, 7.3% of urine samples from patients at risk for Substance Use Disorder (SUD) tested positive for fentanyl.
• 1 kilogram of fentanyl contains nearly 500,000 lethal doses.
• In 2024, DEA agents confiscated 60 million fentanyl laced pills and almost 8,000 pounds of fentanyl powder, enough to produce more than 380 million deadly doses.
• 6.5 million prescriptions for fentanyl were written in 2015.
• 1.9 million prescriptions were sold in 2023, decreasing by 70.8% since 2015.

What is Fentanyl?

Fentanyl is a synthetic opioid, meaning it is not derived from the opium poppy plant. Instead, fentanyl and other synthetic opioids, such as methadone, are made entirely in laboratories.

• Prescription fentanyl has been medically available since 1968.
• Fentanyl patches have been prescribed to treat children as young as 2 years old.
• Illegal manufacture and distribution of fentanyl began in the United States in the 1970s.
• Many analogs are available, all classified under the umbrella term “fentanyls”.
• One analog, carfentanil, is up to 10,000-times more potent than morphine.
• These analogs share many characteristics, including:
  • Profound physical effects. Physical impact includes drowsiness, nausea/vomiting, urinary retention, and pupillary constriction. Severe or prolonged reactions may require medical attention.
  • Highly addictive. The U.S. Drug Enforcement Agency (DEA) has classified fentanyl as a schedule II controlled substance, meaning it has a high potential for abuse, as well as severe physiological and psychological dependence.
  • Available in many forms. Once solely prepared for injection, fentanyl preparations can now be taken orally (pill, tablet, film, blotter paper, etc.), smoked, snorted or sniffed, and absorbed through transdermal patches.
  • Legally prescribed for pain. Fentanyls are most often prescribed in conjunction with other analgesics to ease pain in cancer patients; transdermal patches are typically prescribed to patients who require a steady regimen of opioids to manage severe and/or chronic pain.
  • High similar to morphine. Fentanyl’s effects are comparable to other opioid analgesics, such as morphine. Users experience relaxation, euphoria, and confusion.

How Fentanyl Works

Fentanyl’s effects come on quicker than morphine, but they don’t last as long. The drug remains in the body for over a day, impacting different organs and systems.

• Once ingested, fentanyl is rapidly absorbed by highly perfused tissues like the brain before being redistributed to muscle and fatty tissues and attaching to human plasma proteins.
• In the brain, fentanyl interacts primarily with the mu (μ) opioid peptide receptors, which ultimately produce the medicinal effects or “high” in the user.
• Fentanyl also interacts occasionally with kappa (κ) and delta (δ) opioid receptors.
• The liver metabolizes fentanyl to be excreted by the kidneys.
• Fentanyl’s narcotic effects typically last between 2 and 4 hours.
• After 72 hours, the majority of a fentanyl dose is eliminated from the body through urine or feces.

Fentanyl Overdose Statistics

Overdose deaths from fentanyl are on the rise, increasing 28.8% since 2020, even as OD rates for other drugs have decreased. Many such deaths are users who did not know they ingested fentanyl, and most die from asphyxiation due to the drug’s respiratory depressive effect.

• A dose of 2 mg of fentanyl can be fatal, and about half of all fentanyl-laced pills contain a potentially lethal amount.
• In 2023, fentanyl caused 10,107% more deaths than heroin and 911% more deaths than cocaine.
• In 2018, Delaware reported post-mortem detection of fentanyl in 79% of all overdoses.
• Asphyxiation via respiratory depression – that is, the slowing of the respiratory system – is the leading cause of death in fentanyl ODs.
• Hypoxia – that is, a lack of oxygen in the brain – is often caused by respiratory depression, and another common cause of death in fentanyl ODs.
• Fentanyl’s respiratory effects outlast its analgesic effects.
• Fentanyl ODs increased from 31,335 in 2018 to 72,776 in 2023.
• Carfentanil  is the most potent and dangerous fentanyl analog, with as little as 0.02 mg capable of causing death.
• In addition to its high potency, fentanyl often creates “hot spots”, or uneven concentrations that form when mixed with other drugs, making it one of the most lethal substances on the recreational drug market.
• “Hot spots” result from fentanyl’s inability to blend evenly with other powders, leaving behind undetectable clumps that can contain a fatal dose.

Fentanyl’s Rising Popularity

Fentanyl’s use and availability has increased in the medical community as well as among recreational drug users and addicts. Statistics indicate the overdose epidemic among opioid users is spreading geographically as well as across demographics.

• 69.3% of all overdose deaths (OD) involved fentanyl in 2023.
• In 2018, 46.5% of drug overdose deaths involved fentanyl.
• 58% of U.S. states reported more than a 100% increase in fentanyl overdose death rates between 2019 and 2021.
• From 2019 to 2021, 32% of U.S. states reported more than 200% increase in fentanyl overdose death rates, while 12% saw increases exceeding 300%.
• Fentanyl OD rates increased 2,120% from 2013 to 2023.
• Between 2019 and 2021, adults aged 55 to 64 saw the largest increase in fentanyl overdose death rates, rising by 110%.
• Fentanyl contributed to several high-profile deaths† in the early 21^st Century, including:
  • Singer-guitarists Prince and Tom Petty.
  • Rappers Coolio and Mac Miller.
  • Bestselling author Michelle McNamara.
  • Major League pitcher Tyler Skaggs.

†In each case, investigators determined it was unlikely the deceased knew or understood they were taking such a potent and potentially lethal drug.

COVID-19 Overdose Spike

The National Institute on Drug Abuse (NIDA) reports a spike in overdose deaths between 2019 and 2021. Some health and addiction specialists believe the increase may be related to the stress and isolation during COVID quarantines. Regardless of the cause of the increased death rate, illicitly manufactured fentanyl (and fentanyl analogs) is the most common denominator.

• From 2019 to 2020, fentanyl OD deaths increased by 55.4% year-over-year (YoY), followed by an additional 24.9% increase between 2020 and 2021.
• The 12-month period ending March 2020, which coincided with the initiation of mass quarantines, saw a 24.9% YoY increase in overdose deaths.
• In the twelve months leading up to May 2020, fentanyl overdose deaths increased by 38.4% compared to the previous year.
• Between 2019 and 2021, fentanyl OD death rates increased by 91.2%.

Risk Reduction Facts and Statistics

Drug abuse and addiction is an insidious social problem. If you or someone you know uses fentanyl or drugs of the type that are commonly laced with fentanyl, education is your greatest defense against death.

• Keep a dose of Narcan or naloxone (opioid antidote) on hand. Contact community health services to find out where you can get free doses.
• Only buy from a trusted source. Most people killed by fentanyl overdoses do not realize the substance they’ve taken contained fentanyl.
• Use the buddy system. Make sure a friend knows what you’ve taken, how much, and when.
• Use in a safe environment. Opioids inhibit cognitive ability and make users less aware in general, leaving them vulnerable to other high-risk behavior.
• Smoking or snorting is safer than injecting. There is no safe way to self-medicate or use recreational drugs. Smoking or snorting, however, leaves the user less vulnerable to hot spots and a deadly overdose.
• Avoid mixing fentanyl with other drugs, especially Central Nervous System (CNS) depressants, such as alcohols, barbiturates, and benzodiazepines.
• Know the signs of overdose, such as cyanosis (the skin gets a blue tinge, usually on the hands and feet or around the mouth).

Signs of an Overdose

Fentanyl is deadly. If you know someone who uses opioids, watch for these overdose symptoms.

• Cold, clammy skin
• Blue or purple fingernails and/or lips
• Vomiting or gurgling noises
• Slowed respiration or heartbeat
• Unconsciousness‡

‡If someone is sleeping or unconscious, move them into the recovery position.

Recovery Position

After calling 911, provide rescue breaths if possible, and place any unconscious person in the recovery position while you wait for help to arrive. This allows any bodily fluids to drain out of the mouth and nose, reducing the risk of aspiration and asphyxiation.

1. Place the person on their side.
2. Bend their knees (as in the fetal position).
3. Rest their head on top of the arm closest to the floor.

Fentanyl Regulation

Multiple entities, academic institutions and governing bodies, design legislation to regulate the manufacture and distribution of fentanyl and other such drugs.

• Prior to their discontinuation in September 2024, select oral and buccal fentanyl products were only available through the FDA Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) Access program.
• These same drugs were required to be supplied and administered by a pharmacy or healthcare professional certified by the TIRF REMS Access program.
• Fentanyl confiscations in 2023 were 2,300 times higher than in 2017, reflecting a sharp increase in usage and market availability.

National Drug Early Warning System

In 2014, the National Institute on Drug Abuse (NIDA) launched the National Drug Early Warning System (NDEWS). The system collects and analyzes nationwide data from several different sources.

• The NDEWS is made up of three groups: Scientific Advisory Group (SAG), Sentinel Sites, and Community-Based Health Experts.
• 16 geographical points or “sentinel sites” are designed to monitor shifting trends in drug markets.
• The term “fentanyl” appears more than 200 times in the most recent NDEWS annual Sentinel Site report (2021).
• A recent NDEWS Hotspot Report found that emergency medical services responses to fentanyl overdoses peak on Fridays between 5:00 p.m. to 9:59 p.m.

DEA Fentanyl Data

The Drug Enforcement Agency (DEA) continues to identify fentanyl as the most lethal drug threat the United States has ever experienced. Recent DEA data highlights fentanyl’s widespread availability, growing production, and increase in overdose fatalities.

• In 2019, 17 out 23 Drug Enforcement Agency (DEA) metropolitan field offices categorized the availability of fentanyl as high.
• In 2024, the DEA determined that 5 in every 10 fake pills contained a lethal dose of fentanyl.
• From 2021 to 2023, DEA seizures of powdered fentanyl nearly doubled, rising from 6,875 kilograms to 13,176 kilograms, while seizures of fentanyl pills nearly tripled, increasing from 23.6 million to 79 million.

Fentanyl Manufacture Statistics

Data suggest illegal manufacturers supply most of the fentanyl that is used illicitly. Collecting statistical information on the subject is inherently problematic; the only information available comes from shuttered operations and from the products themselves.

• Legal manufacture of fentanyl products is unlikely to cease despite public outcry about its lethality.
• Fentanyl is a drug with long-term profitability in an industry where getting a drug to market can cost billions of dollars.
• Any slowdown in production would guarantee a loss of revenue for the entire pharmaceutical industry.
• The average cost of research and development for a new drug ranges from $314 million to $4.46 billion.
• Over the past decade, the inflation-adjusted cost of developing a new drug rose by 8.5% per year.
• Illegally manufactured fentanyl may come in the form of pills, powders, candies, blotter paper, nasal sprays, eye droppers, etc.

Geographic Distribution

Most counterfeit fentanyl pills and powders on the American market are produced and trafficked by major Mexican drug cartels, including the Sinaloa and Jalisco cartels; however, law enforcement uncovers a growing number of domestic manufacturers each year.

• An operation in Los Angeles used high-speed pill presses in their process of mixing powdered fentanyl into pill form.
• A manufacturer in New York sold fentanyl made to look like 30mg oxycodone pills.
• A lone operation in Toluca, Mexico supplied most of the fentanyl to the American drug market during the 2006 crisis; traffickers cut their heroin supply with fentanyl causing a massive spike in overdoses.
• Between 2005 and 2007, 1,013 deaths in just six U.S. jurisdictions were linked to fentanyl-laced heroin originating from illicit production facilities, including the Toluca, Mexico operation.
• Most of the fentanyl-laced heroin deaths linked to the Toluca operation occurred in Illinois, Michigan, and Pennsylvania.
• Fentanyl overdose deaths remained relatively stable between 2007 and 2013, after which fentanyl OD rates began to increase.

Medical Uses for Fentanyl

Fentanyl products are intended to be administered by or taken under the instruction of a healthcare professional. While healthcare professionals write fewer opioid prescriptions each year, most pain specialists continue to prescribe it to patients in excruciating pain.

• In 1990, the transdermal patch Duragesic went on the market; it’s widely used by chronic pain sufferers who require a regular dose of opioid analgesics.
• In 1998, the Actiq lozenge or “lollipop” was first prescribed to cancer patients who had become opioid-tolerant and were experiencing breakthrough pain.
• Other legitimate delivery methods include films and transmucosal preparations.
• Rapid onset (RO) preparations of fentanyl are effective within 5 to 15 minutes.
• Common brand names for fentanyl include Abstral, Actiq, Duragesic, and Sublimaze.

Sources

1. Drug Enforcement Administration (DEA), Fentanyl
2. National Institute on Drug Abuse (NIDA), Drug Overdose Deaths
3. The Journal of Pain, Fentanyl Story
4. Mayo Clinic, Fentanyl
5. United Nations Office on Drugs and Crime (UNODC), Fentanyl and its Analogues
6. National Library of Medicine, Fentanyl Absorption
7. Science Direct, Synthetic Opioids
8. Centers for Disease Control and Prevention (CDC), Fentanyl
9. Food and Drug Administration (FDA), Fentanyl
10. Virginia Fusion Center, Fentanyl Outlook & Trends
11. OD Free, Overdose Deaths
12. State Health Access Data Assistance Center (SHADAC), Opioid Crisis During the Pandemic
13. Physician Patient Alliance for Health & Safety, Fentanyl Can Kill You
14. Substance Abuse and Mental Health Services Administration (SAMHSA), Overdose Prevention 
15. National Harm Reduction Coalition, Fentanyl Overdose Prevention
16. United States Attorney’s Office, Fentanyl Traffickers
17. American Medical Association, Overdose Epidemic Report
18. U.S. Department of Health and Human Services, Substance Use During Pandemic
19. Harm Reduction Ohio, How Much Fentanyl Will Kill You?
20. National Drug Early Warning System, Early Warning Network
21. American Scientist, Toxicity of Recreational Drugs