Drug overdose deaths in the US rose to record levels during the Covid-19 pandemic, and a new report from the US Centers for Disease Control and Prevention details the deadly rise of fentanyl.
Typically, the CDC reports overdose data by broader drug categories. Fentanyl, for example, is grouped with other synthetic opioids like tramadol and nitazenes. But for Wednesday’s report, researchers took a closer look at the specific drugs that are included on death certificates for people who died of overdoses, highlighting demographic differences.
Nearly 70,000 people in the US died of drug overdoses that involved fentanyl in 2021, almost a four-fold increase over five years. By 2021, about two-thirds of all overdose deaths involved the potent synthetic opioid, according to the report. Multiple drugs can be reported on one death certificate, and fentanyl is often found along with others, according to the CDC.
Specific information about the drugs involved in deadly overdoses is critical to assess the effects of drug policy and to guide treatment programs, experts say.
“We need to know exactly what people are dying from so we know what services they need to stay alive,” said Caleb Banta-Green, a research professor at the University of Washington School of Medicine’s Addictions, Drug & Alcohol Institute who was not involved in the new report.
Understanding different drug sources – such as prescription tramadol vs. illicit fentanyl – and modes of ingestion are essential factors, he said. They can give additional information about who is using and the relative addiction and overdose potential.
Pharmaceutical fentanyl is a synthetic opioid intended to help patients, such as those with cancer, manage severe pain. It is 50 to 100 times more potent than morphine and typically prescribed in the form of skin patches or lozenges. But most recent cases of fentanyl-related harm, overdose and death in the United States are linked to illegally made fentanyl, according to the CDC.
Fentanyl is significantly more likely to be involved in a deadly overdose than other common drugs, according to the new CDC report.
In 2021, fentanyl was involved in about 22 deaths for every 100,000 people – more than twice as many as the age-adjusted death rate from overdoses involving methamphetamine or cocaine, and more than seven times higher than those involving heroin.
Fentanyl was the most common drug involved in fatal overdoses across age groups, race and ethnicity groups and genders in 2021.
For people younger than 25 and older than 65, the rate was not significantly different than it was for other drugs. But it was exceptionally high among ages 25 to 44.
The rate of overdose deaths involving fentanyl was highest in the Northeast. In the Northwest, however, overdose deaths involving methamphetamine were similar to those involving fentanyl.
This tracks with long-term trends in the US, where drug use has followed distinct patterns in the West and the East, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.
As with fentanyl, rates of overdose deaths involving methamphetamine increased significantly between 2016 and 2021, according to the CDC report.
Overdose deaths from cocaine also jumped between 2016 and 2021, while deaths involving heroin and oxycodone decreased, according to the CDC report.
Overall, the findings in the report aren’t particularly surprising, Volkow said. Fentanyl is overwhelmingly mentioned in reports from emergency rooms, treatment programs and law enforcement.
“It’s just so widespread,” she said.
But the quantitative data corroborates anecdotal reports and offers a path forward.
“These are some very clear statistics that I found very, very useful,” Volkow said. “Understanding these differences is crucial, because then you can target intervention to address the risk.”