This webpage includes the most noteworthy fentanyl statistics and data available in the United States.
Fentanyl Facts and Statistics
Developed in 1960, fentanyl has been prescribed for medical pain management for decades. The drug is widely used in the field of anesthesiology, and in the last twenty years, pain specialists have ordered fentanyl products such as patches and pills with greater regularity. Now, health professionals who study and treat drug abuse call fentanyl the deadliest opioid available on the recreational drug market. With annual death rates on the rise, this miracle breakthrough is a dream for some and a nightmare for others.
|Comparative Annual Overdoses Over 10 Years: Data Table|
|Fentanyl||Heroin||Cocaine||Psychostim.||Nat. & SemiSyn. Opioids|
Fentanyl Overdose Facts and Statistics
As overdose (OD) rates remain relatively steady, fentanyl is an increasingly common factor in such deaths. Even when overall OD rates fall, fentanyl death rates continue to rise. Multiple elements contribute to the drug’s lethality, including a lack of user awareness; many ODs likely don’t realize they’ve ingested fentanyl.
- Fentanyl OD rates increased from 2600 in 2012 to 31,335 in 2018.
- 100k people are projected to die from overdoses of fentanyl in 2020.
- 2 milligrams of fentanyl is a lethal dose, but doses as small as 0.25 milligrams place the user at a high risk of overdose.
- Comparatively, 100mg of heroin and 250mg of cocaine are, respectively, lethal doses.
- Nearly 70% of overdoses involve an opioid; 60% of those overdoses involve fentanyl.
- Drug overdose deaths in the United States decreased by 4.1% between 2017 and 2018; in that same period, synthetic opioid ODs increased by 10%.
- In 2018, Delaware reported post-mortem detection of fentanyl in 72% of overdoses.
- Respiratory depression is the deadliest effect of fentanyl.
- Asphyxiation via respiratory depression – that is, the slowing of the respiratory system – is the main factor in fentanyl ODs.
- Asphyxiation causes hypoxia, a condition that describes a lack of oxygen flowing to the brain.
- Hypoxia can cause permanent brain damage, paralysis, and death.
- Fentanyl’s respiratory effects outlast its analgesic effects.
- Nationally, deaths involving synthetic opioids such as fentanyl increased 10% in that year.
- Carfentinil causes the most overdose deaths of any fentanyl analog.
- Carfentanil is up to 10,000-times more potent than morphine.
- 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 undetectable 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.
Fentanyl’s Rising Popularity
More than 50 years after it was first synthesized, fentanyl’s use and availability has increased in the medical community as well as among recreational drug users and addicts. U.S. Centers for Disease Control and Prevention (CDC) data show the overdose epidemic among opioid users is spreading geographically as well as across demographics.
- 25- to 44-year-old males have seen the greatest increase in synthetic opioid death rates.
- Due to an 88% drop in the price of methamphetamine over a 10-year period, dealers increasingly use fentanyl to cut their product to make up lost profits.
- Powdered fentanyl is often used to cut heroin, cocaine, and MDMA (ecstasy).
- In 2019, 5% of urine specimens in clinics dealing in primary care, pain management, and substance abuse tested positive for fentanyl; that’s up from 1% in 2013.
- From 2013 to 2015, DEA agents confiscated 239 kilograms of fentanyl.
- 1 kilogram of fentanyl contains 250,000 lethal doses.
- Almost 60 million lethal doses were confiscated by the DEA over two years.
COVID-19 Spike Facts and Statistics
Law enforcement and medical communities are alarmed by the rapid rise in deaths from opioid overdose, with illicitly manufactured fentanyl and fentanyl analogs the most common denominator among them. The spike coincides with the onset of the novel coronavirus pandemic. Potential contributing factors include social isolation and loss of income, as well as the rise in cases of anxiety and depression.
- Reports of spikes in overdose rates alarmed officials by May 2020, just two months after the World Health Organization (WHO) declared a pandemic.
- By August, more than 40 states had reported an atypical increase in synthetic opioid overdoses.
- Between January (when the first U.S. case of COVID-19 was confirmed) and March, overdoses increased by 150%.
- As of August 2020, overdose deaths rose by 20% from 2019; 2018 to 2019 saw just a 5% increase.
- Overdoses tripled in March of 2020 compared to March of 2019.
- The Arkansas Naloxone Project recorded 92 “saves” between March and June of 2020.
- That rate has more than doubled since the same period in 2019, when 44 saves were recorded.
- Drug treatment centers report an increase in relapses in long-term sober patients.
- Jacksonville Florida reports a 40% increase in overdose calls.
- Jacksonville’s Fire and Rescue Department administered naloxone an average of 16 times each day in June 2020.
- Milwaukee, Wisconsin reported a 54% increase in drug overdoses between March and April.
- In Shelby County, Tennessee two people die from overdose on an average day.
Geographic Data Distribution
States with more instances of fentanyl confiscation also experienced higher rates of fentanyl overdose. Most fentanyl pills and powders that are eventually sold on the American market originate in China; however, a growing number of domestic manufacturers are uncovered by law enforcement 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 occurred in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey, and Pennsylvania.
- Deaths continued into 2007 at which point fentanyl OD rates declined until 2013.
- The highest death rates by far are seen in large fringe metro areas.
- Counties with populations under 250,000 see the lowest* death rates.
- Arizona has seen the greatest increase in synthetic opioid overdose deaths with a 92.5% increase from 2017 to 2018.
- Also in 2018, Missouri had the highest number of deaths caused by synthetic opioid ODs at 868.
*Counties with fewer than 10,000 people saw even lower death rates, but inefficient data gathering in these areas makes the statistical difference suspect.
|States with the Highest Synthetic Opioid Overdose Death Rates|
Fentanyl Regulation Facts and Statistics
Multiple entities, academic institutions and governing bodies, design legislation to regulate the manufacture and distribution of fentanyl and other such drugs. 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.
- 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 2014, the DEA launched the National Drug Early Warning System (NDEWS).
- 18 geographical points or “sentinel sites” are monitored to track shifting trends in drug markets; NDEWS also collects and analyzes nationwide data.
- In most of these sites, fentanyl is the deadliest substance among drug users.
- Out of 23 reporting DEA metropolitan field offices, 21 reported a year-to-year increase in fentanyl’s local availability.
- 22 field offices categorized fentanyl’s availability as “moderate” or “high.”
- 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|
|Denver Metro||San Francisco County, California|
|King County, Washington||Southeastern Florida|
|Los Angeles County, California||Texas|
|Maine||Wayne County, Michigan|
Risk Reduction Facts and Statistics
Abstaining from use is the best way to avoid an overdose of fentanyl. Drug abuse and addiction is an insidious social problem, however, that’s not going to go away overnight. If you or someone you know uses fentanyl or drugs commonly laced with fentanyl, education is your greatest defense against an untimely death. Know what you and your friends can do to lower your risk of overdose.
- 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.
- 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.
- 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 Overdose
1. Cold, clammy skin
2. Bluish lips and fingernails
3. Pinpoint pupils
4. Slowed or shallow breathing
6. Slow or faint heartbeat
7. Limp limbs
8. Inability to speak
If you think an opioid user has overdosed, call 911 and administer naloxone immediately.
If someone is sleeping or unconscious, put them in the recovery position; this allows any bodily fluids to drain out of the mouth and nose, reducing the risk of aspiration and asphyxiation.
- Place the person on their side.
- Bend their knees (as in the fetal position).
- Rest their head on top of the arm closest to the floor.
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. The U.S. Food and Drug Administration (FDA) has approved drugs containing fentanyl and fentanyl analogs – often classified under the umbrella term “fentanyls” – since 1968; they 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 pain.
- Opioids are also called “narcotics.”
- Opioids derived from the opium poppy are more commonly known as opiates.
- The poppy’s scientific name is Papaver somniferum.
- Semi-synthetic opioids are made with natural opium involved in synthesis.
- Morphine, codeine, and heroin are semi-synthetics.
- Fentanyl is 50- to 300-times more potent than morphine depending on the consumer and on the characteristic being measured (such as pain relief, relaxation, or intoxication, for example).
- Rapid onset (RO) preparations are effective within a minute or two for opioid naïve patients.
- Brand names for fentanyls include Abstral®, Actiq®, Fentora®, Duragesic®, Lazanda®, and Sublimaze®.
- 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.
Fentanyl’s effects are comparable to other opioid analgesics, such as morphine. Users experience relaxation, euphoria, and confusion. Physical effects include drowsiness, nausea/vomiting, urinary retention, and pupillary constriction. Severe or prolonged reaction may require medical attention.
|Fentanyl Street Names|
|Takeover (w crack)||Birria (w heroin)|
How Fentanyl Works
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. Onset of fentanyl’s effects is quicker than morphine, but they don’t last as long. The liver metabolizes fentanyl to be excreted by the kidneys.
- Fentanyl’s effects can last anywhere from 2 to 16 hours.
- Excretion takes anywhere from 6 to 32 hours.
- It acts on neuroreceptors that regulate emotions and pain.
- Over time, the brain adapts to regular exposure to fentanyl and develops a tolerance.
- Once solely prepared for injection, fentanyl preparations can now be ingested many ways.
- Orally (pill, tablet, film, blotter paper)
- Snorted or sniffed
- Absorbed via transdermal patch and eye drops
What is Naloxone?
Naloxone nasal spray (brand name Narcan®) temporarily counteracts the effects of opioids as you wait for emergency services to arrive. Naloxone is also available as in injectable and auto-injectable (pre-filled injections with audio recorded instructions; brand name Evzio®), but nose spray is preferable due to statistics regarding injection histories among opioid addicts and the likelihood of encountering collapsed veins or another such condition that might make an injection ineffective. Community service and healthcare organizations often give out naloxone nasal spray kits for free to people who are opioid dependent. You can get a free naloxone overdose kit by contacting local health services or the National Institute on Drug Abuse (NIDA). The FDA recommends discussion naloxone with your prescribing doctor any time opioids may be part of your medical treatment.
- 7,000 naloxone kits dispensed by the Arkansas Naloxone Project (ANP) since 2016 have reportedly saved over 500 lives in that time.
- The effects of naloxone last 30 to 90 minutes.
- Research scientists nationwide are currently working to develop a longer-lasting opioid antidote to combat fentanyl and other potent synthetics.
- Naloxone relieves OD symptoms for all opioids, including heroin, oxycodone, hydrocodone, and morphine.
- Injections of naloxone are primarily used by emergency medical personnel, such as first responders.
- Most first responders, including police and emergency medical technicians, are trained in how to administer naloxone.
- Though naloxone ostensibly requires a prescription, many state governments have issued orders to pharmacists to sell naloxone to anyone who uses or knows someone who uses opioids.
- Doses of naloxone nasal spray can be purchased in pharmacies for anywhere from $20-$120.
How to Administer Naloxone Nasal Spray
In the event of a suspected opioid OD, call 911 and administer naloxone immediately. Naloxone temporarily alleviates symptoms of OD, including asphyxiation via respiratory depression. Doses of naloxone nasal sprays are packaged with numbered instructions to ensure correct application. Note that you may have to administer a second dose if the person does not continue breathing within 2-3 minutes or if the person starts breathing but then stops again.
- To open the naloxone nasal spray, remove it from its box and peel back the packaging.
- Hold the naloxone nasal spray between your first and middle fingers with your thumb on the bottom plunger.
- DO NOT PRIME OR TEST SPRAY. Tilt the person’s head back (using your free hand beneath their neck) and insert the tip of the nozzle into one nostril.
- Firmly press the plunger to give the entire dose of naloxone.
- Note the time and stay with the person until emergency help arrives; naloxone is effective for 30 to 90 minutes, meaning you may need to give another dose if the person stops breathing again.
|Major Fentanyl Analogs|
Fentanyl in the Healthcare Industry
Fentanyl products are intended to be administered by or taken under the instruction of a healthcare professional. While these professionals call fentanyl a “miracle” analgesic, they’re writing fewer prescriptions each year. This is likely in response to the rise in non-medical use rather than a decreasing faith in the drug; most pain specialists continue to prescribe it to patients who exhibit excruciating pain. 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.
- 6.5 million prescriptions for fentanyls were written in 2015.
- 4 million prescriptions were sold in 2018, decreasing by 40% over three years.
- 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.
- As of 1998, the Actiq® lozenge or “lollipop” is prescribed to pain patients who have become opioid-tolerant or for whom other opioids are ineffective.
- 34.7% of suspected opioid overdoses receive opioids from 10 or more prescribers.
- Prescription and synthetic opioid deaths have outnumbered heroin deaths for over a decade.
- Since the early 1980s, the average cost of research and development for a new drug rose from $75 million to $1 billion.
- That’s an annual growth rate of 36.27%; for comparison, U.S. inflation of the Consumer Product Index (CPI) increased 6.85% per year during that same period.
- United States Drug Enforcement Administration (DEA), Narcotics (Opioids)
- American Pain Society (APS), The Fentanyl Story
- U.S. Department of Justice (DOJ) and DEA, Drug Fact Sheet: Fentanyl
- Centers for Disease Control and Prevention (CDC), Opioid Overdose: Fentanyl
- CDC, Prescription Behavior Surveillance System Issue Brief
- CDC, Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016
- Harm Reduction Ohio, How Much Fentanyl Will Kill You?
- DEA Intelligence Brief, Counterfeit Prescriptions Containing Fentanyls: A Global Threat
- DEA Diversion Control Division, Drug and Chemical Evaluation Section: Fentanyl
- Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) Access, An Overview for Patients and Caregivers
- CDC Newsroom Releases, U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids
- National Library of Medicine (NLM), Fentanyl-related Compounds and Derivatives: Current Status and Future Prospects for Pharmaceutical Applications
- Independent NewsMedia, The Battle of Addiction During the Time of Novel Coronavirus
- U.S. Department of Veteran Affairs (VA), Opioid Overdose Rescue with Naloxone Nasal Spray
- Fox Local New Release, Number of Overdose Saves Tops 500 Through Arkansas Program
- First Coast News, Overdose Calls up 40% During COVID-19 Pandemic
- CDC, Drug Overdose Deaths in the United States, 1999–2018
- CDC, Synthetic Opioid Overdose Data
- DEA, Statement of Paul E. Knierim Deputy Chief of Operations, Office of Global Enforcement Drug Enforcement Administration Before the Subcommittee on Africa, Global Health, Global Human Rights and International Organizations Committee on Foreign Affairs U.S. House of Representatives
- NIDA, Naloxone
- DEA, 2019 National Drug Threat Assessment
- National Center for Health Statistics (NCHS), Drug Overdose Deaths in the United States, 1999-2018
- American Medical Association (AMA), Issue brief: Reports of Increases in Opioid-Related Overdose and Other Concerns During
- NIDA, DrugFacts: Fentanyl
- Overdose Protection Mapping Application Program (OPMAP), The Consequences of COVID-19 on the Overdose Epidemic: Overdoses Are Increasing
- National Public Radio (NPR), U.S. Sees Deadly Drug Overdose Spike During Pandemic