U.S. Deaths Involving Synthetic Opioids Are Unprecedented; Policymakers Must Pursue Innovative Strategies to Reverse Tide
Aug 29, 2019
Deaths involving synthetic opioids, such as fentanyl, increased from roughly 3,000 in 2013 to more than 30,000 in 2018. This analysis provides decisionmakers, researchers, media outlets, and the public with insights intended to improve their understanding of the synthetic opioid problem and how to respond to it. Limiting policy responses to existing approaches will likely be insufficient and may condemn many people to early deaths.
Deaths involving synthetic opioids in the United States increased from roughly 3,000 in 2013 to more than 30,000 in 2018. In fact, synthetic opioids like fentanyl are now involved in twice as many deaths as heroin. This book offers a systematic assessment of the past, present, and possible futures of synthetic opioids in the United States. It is rooted in secondary data analysis, literature reviews, international case studies, and key informant interviews. The goal is to provide decisionmakers, researchers, media outlets, and the public with insights intended to improve their understanding of the synthetic opioid problem and how to respond to it.
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.
Insights From Mortality and Seizure Data in the United States
Assessing Explanations for the Recent Rise in Synthetic Opioids
International Experiences with Synthetic Opioids
Some Possible Futures for Fentanyl and Other Synthetic Opioids
Background Information on Synthetic Opioids
The Economics of Mexican Heroin and Fentanyl
Opportunities for Better Surveillance and Monitoring
Supplemental Information on Data and Methods
Details on Key Informant Interviews