A study released on October 25, 2019 by the Centers for Disease Control and Prevention shows fentanyl cutting a swath of death and destruction across the northeastern United States and the industrialized Midwest in 2017. That year, the synthetic opioid 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 totally different in the nation’s 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 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 nation’s 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.
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. “That’s not true anymore. We are in the killing fields now.”
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 epidemic’s 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 fentanyl’s uptake spread across the country, fueled in part by its broader use in spiking drugs such as cocaine and methamphetamine, Ciccarone said.
Fentanyl was slow to reach the western states but that picture has already begun to change. A database of drug death in California suggests that fentanyl’s increased presence is already being felt in the state. In 2018, fatal opioid overdoses linked to fentanyl grew to 743 from 429 in 2017, representing close to a third of the state’s 2,311 opioid-related deaths.
Fentanyl is also appearing in the form of counterfeit pills sold as the prescription painkillers oxycodone and hydrocodone, as well as the anti-anxiety drug Xanax. Last year, investigators at the Food and Drug Administration dismantled a network of counterfeiters in Northern California that was turning out fake Xanax and Percocet pills with Chinese chemicals and equipment.
Drug users’ behaviors have changed in ways that create a potential opening for fentanyl in the West. In parts of the East and Midwest, a practice called “goofballing” or “speedballing” — in which drug abusers mix heroin with stimulants such as methamphetamine or cocaine — has become a popular way to achieve a more intense high. Those who do not typically use opioid drugs and have not developed a tolerance for them, are in danger of a fatal overdose.
“Fentanyl is still taking off, we haven’t seen that cycle peak yet. But if current trends continue, Ciccarone said, the outcome could be “horrible.”