Fentanyl Involved in Half of All Fatal Overdoses: Here Are the States Most at Risk

First it was pain pills driving the opioid overdose epidemic, then it was heroin. Now, it's the synthetic opioid fentanyl. Last year, fentanyl was implicated in roughly half of all overdose deaths, and there is no sign that the problem is abating.


The drug is inexpensive and easy to manufacture and smuggle. It comes from chemical factories in China and makes its way to the U.S. either through online purchases shipped via the U.S. Postal Service, UPS, and other private carriers; smuggled in bulk through ports; or shipped to Mexico in either final or precursor form, where it is then diluted with fillers, marketed as heroin or other illicit drugs, and then smuggled into the U.S.

Fentanyl is about a hundred times more powerful than morphine. A quantity the size of a match head would kill most drug users. It's been around since the 1980s—the "China White synthetic heroin" overdose clusters in the late 1980s were actually fentanyl—but has really come onto the scene in the last five years.

According to the Centers for Disease Control and Prevention, fentanyl took off in 2013, driving what the agency calls the "third wave" of the opioid epidemic, after prescription pain pills and heroin. In 2012, fentanyl was involved in only 6 percent of the 41,000 fatal drug overdoses that year, but it was involved in half of the 72,000 overdose deaths last year. In raw numbers, that's a jump in fentanyl overdose deaths from about 2,500 deaths in 2012 to a whopping 36,000 deaths last year—a more than tenfold increase.

But those deaths aren't spread evenly across the country. The percentage of fatal ODs involving fentanyl is only in the teens on the West Coast and in the intermountain West, a far cry from the situation on the East Coast and Appalachia. In six states, fentanyl is implicated in more than 60 percent of all overdose deaths. Here they are in rank order:

  1. Massachusetts, 85 percent

  2. New Hampshire, 83 percent

  3. Maine, 66 percent

  4. Rhode Island, 65 percent

  5. Ohio, 64 percent

  6. Maryland, 60 percent

It appears that New England is the epicenter of the fentanyl death crisis, but its impact is also being strongly felt in the Mid-Atlantic and Midwestern states. In addition to the six states above, the following states also report fentanyl being involved in more than half of all fatal overdoses: Connecticut, Delaware, Florida, Michigan, Pennsylvania, Vermont, Virginia, West Virginia, and Wyoming, as well as Washington, D.C.

While drug users everywhere need to be keenly aware of the possibility of fentanyl-contaminated illicit drugs (and even counterfeit pain pills), it is clear that addicts in Boston or Bangor face a greater threat than those in Bakersfield or Boise. Still, everyone involved in using illicit powders should be taking steps to protect themselves. Two of the most effective street-level interventions are having the opioid overdose reversal drug naloxone on hand and resorting to drug testing via the use of fentanyl test strips, which can quickly and easily alert users to the presence of the drug.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

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