Fentanyl Abuse Statistics

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

Highlights

53%
Fentanyl is a factor in more half of overdose deaths.
2MG
Less than 0.07 ounces of fentanyl causes certain death.
43K
Statistics indicate 42,700 fentanyl overdose deaths in 2020.

Bar Graph: Recreational Drug Toxicity with median effective dose expressed as a percentage of median lethal dose

Fentanyl Statistics

First developed in 1959-60, Fentanyl is 50- to 300-times more potent than morphine. Valued as a “miracle drug” by pain specialists, skyrocketing overdose rates have made for more conservative usage.

  • 42,687 overdose deaths (OD) involved fentanyl in the 12 months leading up to May 2020.
  • Fentanyl OD rates are rising 2.5 times faster than heroin ODs.
  • Fentanyl ODs outpace prescription opioid ODs 550.94%.
  • 5% of urine specimens in clinics dealing in primary care, pain management, and substance abuse test positive for fentanyl.
  • 1 kilogram of fentanyl contains 250,000 lethal doses.
  • From 2013 to 2015, DEA agents confiscated 239 kilograms or 59.75 million lethal doses of fentanyl.
  • 6.5 million prescriptions for fentanyls were written in 2015.
  • 4 million prescriptions were sold in 2018, decreasing by 40% over three years.
1 teaspoon = 5 grams
Fentanyl Consumed Risk of Overdose
0.00005 grams Death unlikely
0.0001 grams Moderate risk of death
0.00015 grams Significant risk of death
0.00025 grams High risk of death
0.00004 grams Very high risk of death
0.0007 grams Death likely
0.001 grams Near-certain death
0.002 grams Death certain

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.

  • Fentanyl is a semi-synthetic opioid.
  • Semi-synthetic opioids are made with natural opium involved in synthesis.
  • Morphine, codeine, and heroin are semi-synthetics.
  • Prescription fentanyl has been available since 1968.
  • Fentanyl has been prescribed to treat children as young as 2 years old.
  • Illegal manufacture and distribution of fentanyl began no later than 1979.
  • 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 reaction 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 transdermal patch.
    • 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.
Major Fentanyl Analogs
∝-mefentanyl Alfentanil Brifentanil
Carfentanil Lofentanil Mefentanyl
Mirfentanil Ohmefentanyl Phenaridine
Remifentanil Sufentanil Trefentanil

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 molecules are distributed in fat and attach to human plasma proteins.
  • The blood stream then delivers fentanyl to the brain, where it acts preferentially on the μ-opioid peptide receptors.
  • To a lesser extent, it’s also active with κ-opioid and delta opioid receptors.
  • These receptors ultimately produce the medicinal effects or “high” in the user.
  • The liver metabolizes fentanyl to be excreted by the kidneys.
  • Fentanyl’s narcotic effects can last anywhere from 2 to 16 hours.
  • Excretion takes 6 to 32 hours.

Bar Graph: 12-month Overdose Death Rates

Fentanyl Overdose Statistics

Overdose deaths from fentanyl are on the rise, nearly doubling annually, 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.

  • 2 mg of fentanyl is a lethal dose, but doses as small as 0.25 mg place the user at a high risk of overdose.
  • Comparatively, a lethal dose of heroin is 100 mg while 250 mg of cocaine is a lethal dose.
  • In 2018, Delaware reported post-mortem detection of fentanyl in 72% 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 another common cause of death.
  • Fentanyl’s respiratory effects outlast its analgesic effects.
  • Fentanyl ODs increased from 2,600 in 2012 to 31,335 in 2018.
  • Carfentanil causes the most overdose deaths of any fentanyl analog.
  • In addition to its high potency, the “hot spots” it leaves in cutting other drugs makes fentanyl among the most lethal substances available on the recreational drug market.

A hot spot is a high concentration of fentanyl within a mix of other product(s). Fentanyl’s molecular nature does not allow it to mix evenly into other powders without leaving behind indetectable clumps. In order to fully mix with another powder, the concoction must be combined with a liquid and shaken before allowing the liquid to evaporate, returning the concoction to a powdered form. Failure to perform this final step all but guarantees hot spots of pure fentanyl in the final product.

Line Graph of Comparative Overdose Deaths, Fentanyl goes from lowest number of ODs in 2008 to by far the highest number of ODs in 2017, surpassing heroin and cocaine

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.

  • 52.7% of all overdose deaths (OD) involve fentanyl.
  • From March 2018 to February 2019, 47% of drug overdoses involved fentanyl.
  • 20% of U.S. states report at least a 98% annual increase in opioid overdose deaths.
  • This indicates a 31.57% increase in fentanyl deaths, though some year-over-year increases spike as high as 200%.
  • Fentanyl OD rates increased 1,105% from 2012 to 2018.
  • Almost 60 million lethal doses were confiscated by the DEA over two years.
  • 25- to 44-year-old males have seen the greatest increase in death rates.
  • Fentanyl contributed to several high-profile deaths† in the early 21st Century, including:
    • Singer-guitarists Prince and Tom Petty.
    • Rappers Mac Miller and Lil Peep.
    • 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.

Fentanyl Street Names
Blonde Blues Dance Fever
Fenty Freddy Fuf
Goodfellas Great Bear Opes
Poson Birria (w heroin) Takeover (w crack)

Line Graph: Opioid Overdose Deaths in 2020 quarantine compared to the same time period in 2019

COVID-19 Overdose Spike

The CDC reports a spike in overdose deaths throughout 2020. 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 June 2018 to July 2019, OD rates increased by 21.5% year-over-year (YoY)
  • The number of overdose deaths rose by 38.4% YoY during the 12-month period leading up to May 2020.
  • The 5th week of March 2020, which coincided with the initiation of mass quarantines, saw a 200% YoY increase in overdose deaths.
  • Throughout the month of March, the YoY increase was 171.89%.
  • From January 1st until the first of May 2020, the average YoY increase was 128.63%.
  • During that same period, overdose deaths accumulated 89.03% faster than those in the previous year.

Line Graph of cumulative overdose deaths early in COVID quarantine compared to the same time period in 2019

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 or the National Institute on Drug Abuse (NIDA) 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 on foil is safer than injecting or snorting. There is no safe way to self-medicate or use recreational drugs. Smoking, 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.)

Stacked Area Graph: the number of Fentanyl Deaths Compared with All Other Overdose Deaths

Signs of an Overdose

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

  • Cold, clammy skin
  • Cyanosis
  • Pinpoint Pupils
  • Slowed respiration
  • Unconsciousness‡

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

Diagram: Recovery Position

Recovery Position

After calling 911, 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.

  • Some oral preparations are only available through the Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) Access program.
  • These same drugs must be supplied and administered by a pharmacy or healthcare professional certified by the TIRF REMS Access program.
  • Confiscations of fentanyl are on the rise, reflecting increased usage and market availability.
  • Fentanyl confiscations increased 150% from 2012 to 2014.
  • In a year, the DEA seizes as many as 19.92 million lethal doses of fentanyl.

DEA Fentanyl Data

In 2014, the DEA launched the National Drug Early Warning System (NDEWS). The system collects and analyzes nationwide data. It also makes use of 18 geographical points or “sentinel sites” designed to monitor shifting trends in drug markets.

  • 23 Drug Enforcement Agency (DEA) metropolitan field offices reported an increase in controlled prescription drug availability.
  • 17 of those offices categorized the rate of increase as high.
  • In most of these sites, fentanyl is the deadliest substance among drug users.
  • The word “fentanyl” appears more than five times per page in the most recent NDEWS annual report (2020).
NDEWS Sentinel Sites
Atlanta Metro New York City
Chicago Metro Philadelphia
Denver Metro San Francisco County, California
King County, Washington Southeastern Florida
Los Angeles County, California Texas
Maine Wayne County, Michigan

U.S. Map of Opioid Prescription Overdose Rates by State; that is, overdose deaths to prescription ratio

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 over a billion dollars.
  • Any slowdown in production would guarantee a loss of revenue for the entire industry.
  • Since the early 1980s, the average cost of research and development for a new drug rose from $75 million to $1 billion.
  • The cost of R&D for a new drug rose at an annual growth rate of 36.27%; U.S. inflation of the Consumer Product Index (CPI) increased 6.85% per year during that same period.
  • Illegally manufactured fentanyl may come in the form of candies, blotter paper, pills, powders, nasal sprays, eye droppers, etc.

Geographic Distribution

Most counterfeit fentanyl pills and powders on the American market originate in China; however, law enforcement uncovers a growing number of domestic manufacturers each year.

  • An operation in Los Angeles used pill presses and ventilation equipment 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.
  • 1,013 deaths from fentanyl-laced heroin nationwide could be traced to the Toluca operation.
  • Most of the Toluca fentanyl deaths occured in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey, and Pennsylvania.
  • Deaths continued into 2007 at which point fentanyl OD rates declined until 2013.

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 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 pain patients who had become opioid-tolerant or for whom other opioids were ineffective.
  • Other legitimate delivery methods include films and transmucosal preparations.
  • Rapid onset (RO) preparations of fentanyl are effective within 2 minutes.
  • Brand names include Abstral, Actiq, Duragesic, and Sublimaze.

Sources

  1. U.S. Department of Justice (DOJ) and DEA, Drug Fact Sheet: Fentanyl
  2. United States Drug Enforcement Administration (DEA), Narcotics (Opioids)
  3. American Pain Society (APS), The Fentanyl Story
  4. Everyday Health, 9 Celebrities Who Have Died from Painkiller ODs
  5. Wikipedia, Recovery Position
  6. Centers for Disease Control and Prevention (CDC), Opioid Overdose: Fentanyl
  7. CDC, Prescription Behavior Surveillance System Issue Brief
  8. DEA Diversion Control Division, Drug and Chemical Evaluation Section: Fentanyl
  9. Harm Reduction Ohio, How Much Fentanyl Will Kill You?
  10. DEA Intelligence Brief, Counterfeit Prescriptions Containing Fentanyls: A Global Threat
  11. CDC Newsroom Releases, U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids
  12. National Library of Medicine (NLM), Fentanyl-related Compounds and Derivatives: Current Status and Future Prospects for Pharmaceutical Applications
  13. American Scientist, The Toxicity of Recreational Drugs
  14. CDC Newsroom, Overdose Deaths Accelerating During COVID-19
  15. Anesthesia & Analgesia, The Minimal Effective Dose of Fentanyl to Prevent Emergence Agitation in Children
  16. National Institutes of Health, National Center for Biotechnology Information, Fentanyl-Related Deaths: Demographics, Circumstances, and Toxicology of 112 Cases
  17. Orange County Register, Fentanyl Killed 1,649 People in California Over 5 Years, A Number Dwarfed by Other States