Drug Use and Fentanyl Overdose Deaths in the United States

A significant number of people lose their lives due to drug overdoses every year worldwide. Drug use has been on the agendas of government and international organizations because of its prevalence. The governments have spent a massive amount of money to counter narcotics, but their efforts are far from yielding the expected results. According to the United Nations World Drug Report, 1 in every 17 people aged 15 to 64 used a drug in 2021. Drug users grew 23 percent from 240 million in 2011 to 296 million in 2021.

The most considerable group of users falls under cannabis, with 219 million users in 2021, followed by amphetamine users with 36 million, cocaine users with 22 million, and ecstasy-type substances with 20 million. Concerning gender type user breakdown, female users are higher in amphetamine-type stimulants, while men are dominant users of opiates. It should be noted that opioids are the biggest category of severe drug-related harm.

Drug Use in the United States

The United States (US) is not unique in terms of how it is exposed to natural threats such as wildfires and hurricanes and human-caused risks such as mass shootings, but it also records a high number of drug addicts and drug overdose deaths. As seen in Figure 1 below, drug overdose deaths steadily rose between 2017 and 2022, from 70,237 to 109,680, respectively. In 2021, 67.8 percent of overdose deaths included opioids, followed by cocaine in 21.2 percent of the cases, Psychostimulants in 20.6 percent, and methadone in 4.03 percent.

Figure 1: Drug Overdose Deaths From 2017 to 2022

The deepening fentanyl crisis was the most significant factor in these rising numbers, accounting for almost 80 percent of overdose deaths. Non-medical opioid use was 60 million in 2021, and nearly half used opiates (mainly heroin). The US and Canada are two leading countries that record a sizeable increase in opioid users, driven by overdose deaths predominantly caused by fentanyl. Fentanyl overdose deaths significantly increased from 68,300 in 2020 to 79,770 in 2022, as seen in Figure 2.

Figure 2: Opioid Overdose Deaths between 2017 to 2022

Figure 3 below shows the total annual overdose deaths by State. California and Florida were the two states with the most overdose deaths in 2021, followed by New York, Pennsylvania, and Ohio.

Figure 3: Total Number of Overdose Deaths by State

Fentanyl is a synthetic opioid classified as pharmaceutical fentanyl and illegally made fentanyl. Pharmaceutical fentanyl is prescribed by doctors and used to treat severe pain and advanced-stage cancer. Illegally made fentanyl is produced in the laboratories by the traffickers and sellers. It is available on the drug market as liquid and powder. Powdered fentanyl looks like many other drugs and is commonly added to illegal drugs. It is made into pills that resemble other prescription opioids.

At the end of the first decade of the 21st century, cocaine use was on the wane, and the opioid crisis has been linked to the recrudescence of heroin use in the US. In the early 2000s, pharmaceutical companies promoted fentanyl as a pain killer, saying it is a strong painkiller and not addictive. Therefore, prescription medicines played a crucial role in the scary journey of fentanyl use in the US. In addition to Fentanyl, Xanax is another kind of prescription medication manufactured in the US, and in some cases, the counterfeit Xanax has been infused with fentanyl.

Americans were hooked on Oxycodone until the early 2010s. When fentanyl-included painkillers became less available, the addicts gravitated towards heroin, which was cheaper and easily accessible on the streets. Then, its broad availability made fentanyl one of the most consumed drugs in the US, hitting the states of Michigan, Ohio, and Indiana due to unemployment and poverty stemming from the closing of factories.

Several factors are essential in why the country has such a severe opioid problem. The first one is the demand. The increasing number of addicts seek more potent drugs and end up with drugs mixed with fentanyl. According to the experts, nothing can stop a drug addict from trying to access the drugs consumed daily. Its easy access is also another factor why addicts increasingly use it. Moreover, the distribution system makes it available to drug addicts. Individual networks and criminal networks provide fentanyl-included drugs to addicts. Individual networks use social media and the dark web to distribute fentanyl.

In contrast, criminal networks are Mexican drug cartels that import the precursors of fentanyl from China and then produce them in primitive labs in territories not controlled by government authorities in Mexico. Notably, the profitability of fentanyl trafficking is another factor that lures individuals to become involved in fentanyl trafficking. Finally, the lack of law enforcement is another factor. Law enforcement cannot check every suspicious package and mail service used to transfer fentanyl from overseas to the United States.     

A Perspective from Human Anatomy: Why is Fentanyl Deadly?

Fentanyl is potent; its 2 mg is enough for a fatal dose. It is 50 times stronger than heroin and 100 times more than morphine. In most cases, the users are not aware of how much fentanyl they consume at once because it is laced with other types of drugs. Overdose deaths involving opioids significantly rose from 2016 to 2021, as seen in Figure 4. Fentanyl is generally cut with heroin, cocaine, methamphetamine, or marijuana. 

Figure 4: Number of Overdose Deaths Involving Opioids, United States, 1999-2021

Opioids and opiates are different from each other. Opiates are a group of drugs used to treat pain and obtained from poppy sap and poppy plants. Morphine and codeine are two examples of opiates. On the other hand, opioids involve illegal drugs such as heroin, synthetic opioids such as fentanyl, and painkillers that the providers prescribe.

Opioids encompass any compound that may have an action on opioid receptors. The human body makes its opioids to bind those receptors. They are called endogenous opioids, and one is endorphin, which stands for endogenous morphine. One example of this is opioids. However, exogenous opioids come from external sources such as heroin, morphine, or fentanyl that can bind those receptors. When someone feels pain, opioids are functional as they bind to receptors and change the pain perception.

Opioids can have an effect or modulate the signal at the synapse. When fentanyl binds to the endorphin-releasing receptors, it can mess them up. Therefore, the user’s body cannot respond to low oxygen or high carbon dioxide levels. When an opioid is bound to receptors, it cannot convey that the oxygen is low and carbon dioxide is too high. As a result, the user stops breathing and dies. Snorting and injecting fentanyl can have quicker and more deadly results than swallowing it because it can immediately get absorbed in the body.

To counter the fentanyl overdose deaths, the prevention, harm-reduction, and recovery strategies are used. Naloxone and Narcan are two medicines that reverse an opioid overdose. These medicines work by binding the receptor and bumping the fentanyl off, allowing the user to breathe again. They can be sprayed in the nose or injected, reversing an opioid overdose. It is noteworthy to underline that its effect lasts 30 minutes, and fentanyl can re-attach to the receptor and may cause a person to stop breathing again. In some cases, Naloxone or Narcan do not work because of the spread of derivatives of fentanyl. For example, carfentanil is about 100 times more potent than fentanyl and extremely dangerous and lethal.

To conclude, based on the current supply and demand system and availability of illegal drugs, the world will continue to record a considerable number of drug addicts. The current trends indicate that the US would follow suit, in which the country will report not only increasing numbers of drug users but rising numbers of fentanyl overdoses. A variety of counter-narcotics strategies are needed for an effective fight. Strategies are urgently needed to stop its supply, target individual and criminal networks, prevent its demand, and provide better health facilities for drug addicts. Furthermore, pharmaceutical companies must produce more effective drugs that reverse the impacts of fentanyl overdoses. 

Ahmet Cengiz
Ahmet Cengiz
Ahmet Cengiz is a senior student at University of Virginia (UVA). He majors on Spanish and takes pre-medical classes. He is involved in research in hospitals, including in Mexico and Spain and studies human anatomic perspectives of painkillers and fentanyl overdoses.