Fentanyl, the painkiller that’s more powerful than morphine, oxycodone, and heroin, has become an especially worrisome chapter in America’s ongoing opioid saga.
Just a few grains of pure fentanyl can prove a fatal overdose. Over the past few years, fentanyl has hit some American towns especially hard, producing a quick string of overdoses and deaths. But what’s the situation like nationwide? A new letter from the Office of National Drug Control Policy offers some clues.
In February, the House Energy and Commerce Committee, which previously worked on major anti-addiction legislation such as the Comprehensive Addiction and Recovery Act, sent the Office of National Drug Control Policy a list of questions about fentanyl, as theWall Street Journal reports. Late last week, the office finally issued a reply. The response offers a look into what American officials know about this developing public-health crisis. Below, the five most important takeaways.
How Much Fentanyl Is There in the United States?
This is a hard question to answer with exact numbers. Seizure data does suggest more and more fentanyl is entering the country. In 2016, authorities encountered fentanyl 26 percent more frequently during drug busts than they did in 2015 — and 250 percent more frequently than they did in 2014.
How Many Americans Does Fentanyl Hurt or Kill Every Year?
Because not all deaths are examined carefully and tests for fentanyl aren’t required in death investigations, this is another tough question to answer. Here’s what we do know: In 2015, the Centers for Disease Control and Prevention (CDC) recorded 9,580 deaths in America that involved unspecified “synthetic opioids (other than methadone),” which the CDC assumes is mostly fentanyl. That’s three times as many deaths as in 2013, during which the CDC records 3,105 Americans dying with unknown synthetic opioids in their systems.
Experts think these numbers are almost certainly underestimates of the true number of fentanyl-involved deaths in America, but they don’t know by how much.
Where Does Fentanyl Come From?
Fentanyl on the black market comes primarily from labs in China, which can mail it directly to the U.S. In small amounts, fentanyl is difficult to detect in mail, the Office of National Drug Control Policy letter says.
Possibly some China-made fentanyl is shipped first to Mexico before it enters the U.S. Mexican dealers may also order precursor chemicals from Chinese labs, finish making the drug, and then smuggle it over the Southwest border.
Canadian dealers are especially likely to press fentanyl into what look like prescription pills and smuggle that into the U.S. Counterfeit tablets are already a known problem within Canada: When Pacific Standard visited Vancouver, British Columbia, last year, pill-users said that they were afraid of unwittingly taking fentanyl-laced tablets.
The Drug Enforcement Administration believes legally made, diverted fentanyl makes up only a small part of the illicit fentanyl market in the U.S.
How Is Fentanyl Sold?
Powdered fentanyl can be mixed in with white-powder heroin; sold as “synthetic heroin”; or pressed into what appear to be pills of OxyContin, Xanax, and other prescription painkillers. The Department of Homeland Security reports it seized 58 pill-making machines in the 2016 fiscal year.
Users may or may not know that there’s fentanyl in the products they buy. If they don’t know, they may end up overdosing because they’re not aware of just how powerful the product is.
What States Are Being Hit the Hardest by Fentanyl?
The letter names states in which fentanyl-involved deaths have shot up the most dramatically between 2014 and 2015. Michigan, New York, and New Jersey top the list. But these aren’t necessarily the states that have the highest rate of fentanyl-involved deaths. Among the states the letter includes data for, those hardest-hit are New Hampshire, Massachusetts, and Ohio.