A rigorous effort to track U.S. overdose deaths and the drugs that caused them offers a snapshot of a fentanyl epidemic on the cusp of a westward shift.
A study released Friday by the Centers for Disease Control and Prevention shows the synthetic opioid cutting a swath of death and destruction across the northeastern United States and the industrialized Midwest in 2017. That year, fentanyl was the drug cited most often as a cause of fatal overdoses in all five regions lying east of the Mississippi River, as well as the neighboring region that includes Iowa, Missouri, Kansas and Nebraska.
The picture was starkly different in the nations western states, where fentanyl barely registered as a cause of death. Instead, methamphetamine was the drug most often linked to overdose deaths in 2017.
Nationwide, fentanyl played a role in nearly 4 out of 10 fatal overdoses in 2017, more than any other drug. For every 100,000 Americans, there were 8.7 fentanyl-related deaths that year, according to the study from the CDCs National Center for Health Statistics.
Fentanyl, a drug at least 10 times more powerful than morphine, is phenomenally inexpensive per dose, according to a recent Rand Corp. report on the future of synthetic opioids. Widely used by cartels and drug dealers to boost the potency of other drugs of abuse, it was cited as a cause of death sometimes alone but frequently in combination with other drugs in 27,299 fatal overdoses across the country in 2017.
Those fentanyl-involved deaths were densely concentrated in the nations northeastern, mid-Atlantic and upper midwestern states. Only 1,769 overdoses linked to fentanyl fewer than 7% of the national total were recorded in the regions that include Louisiana, Arkansas, Texas, Oklahoma, Colorado, Wyoming, the Dakotas and all of the states stretching westward from there.
Illicit fentanyl is thought to have penetrated the U.S. drug supply earliest and hardest in New England. In 2017, that region had a fentanyl overdose death rate of 22.5 per 100,000 about 15 times higher than the prevailing rate throughout the western United States.
That picture has already begun to change, experts said. In 2018 and the opening months of 2019, evidence of fentanyls westward diffusion began to build.
Fentanyl was rare for a minute on the West Coast, said Dr. Daniel Ciccarone, a physician and medical anthropologist at UC San Francisco who studies trends in illicit drug use. Thats not true anymore. We are in the killing fields now.
As the scourge of fentanyl tightens its grip on western states, it could usher in a new chapter of the opioid epidemic, he warned.
The opioid epidemic is maturing, Ciccarone said.
The current public health crisis can be traced to the 1990s, when doctors began overprescribing opioid narcotics with encouragement from the drugs manufacturers.
By 2010, access to prescription pills was squeezed as doctors wrote fewer prescriptions, abuse-resistant formulations reached pharmacies, and efforts to prevent the diversion of pain medication to the black market were stepped up. Those addicted to opiates responded with a surge in heroin use, triggering the epidemics second wave.
Then in 2013, cheap and deadly fentanyl began reaching American shores from Chinese labs, launching a third wave of the opioid epidemic. A fourth wave could see fentanyls uptake spread across the country, fueled in part by its broader use in spiking drugs such as cocaine and methamphetamine, Ciccarone said.
The synthetic opioid, which can cause death in a non-opioid user at doses as low as 2 milligrams, has already been seen in a variety of illicit drugs in the West. In addition to being cut into cocaine and methamphetamine, it is being pressed into counterfeit pills that look like exact replicas of prescription narcotic and anti-anxiety medications. Eventually, fentanyl is expected to find its way into heroin across the West.
