Drug cartels turn to a synthetic opioid 100 times stronger than fentanyl, 'killing hundreds of unsuspecting drug users'

The chemical makeup of carfentanil. The drug is legally used to  
anesthetize large animals such as elephants and rhinoceroses. 

Carfentanil is a deadly "weapons-grade" synthetic opioid that illicit drug makers are adding to other drugs as a potent substitute for fentanyl. The drug, which authorities say is "10,000 times more potent than morphine and 100 times stronger than fentanyl, has seen a drastic resurgence across the U.S., killing hundreds of unsuspecting drug users," report Hallie Golden and Jim Mustian of The Associated Press.

Carfentanil's presence in illegal drugs sold in the U.S. has surged since the Chinese government's more recent "crackdown on the sale of precursors used to make fentanyl," AP reports. "Those regulations are likely prompting traffickers in Mexico to use carfentanil to boost the potency of a weakened version of fentanyl."

The sheer potency of carfentanil is what makes it so dangerous for anyone who takes drugs not prescribed by their doctor. Frank Tarentino, the U.S. Drug Enforcement Administration chief of operations for its northeast region, which stretches from Maine to Virginia, told AP, "You’re talking about not even a grain of salt that could be potentially lethal. This presents an extremely frightening proposition."

While some Mexican drug cartels may be making carfentanil in their own labs, others are purchasing it from darknet marketplaces. Regardless of where it originates, it's making its way onto American streets. Golden and Mustian write, "In 2025, DEA labs identified carfentanil 1,400 times in U.S. drug seizures, compared with 145 in 2023 and only 54 in 2022."

Russia used an aerosol form of carfentanil as a chemical weapon to subdue Chechen separatists in 2002, AP reports. It is legally used to anesthetize large animals, such as elephants.

Michael King Jr., founder of the Opioid Awareness Foundation, told AP, “It’s like a biological weapon. If the world thinks we had a problem with fentanyl, that’s minute compared to what we’re going to be dealing with with carfentanil.”

Microgrant deadline extended for reporting on opioid settlement funds

Reporting on Addiction, a collaborative movement staffed by media professionals working to address addiction, is extending its deadline to apply for 2025 microgrants for journalists reporting on opioid settlement funds in Kentucky, Maine, New Jersey or New York.

June 20 is the new deadline. Apply here.

As billions in opioid settlement funds enter the U.S. economy, how that money will be spent is unclear. Especially for individuals, families and communities touched by the opioid and fentanyl crisis, having journalists who use their investigative skills to follow who spends the money and on what is of vital importance. Watchdog reporters are needed as a primary, trustworthy source for people who want to hold public officials accountable for how these funds are used to address the addiction crisis.

To support this vital journalistic effort, Open Society Foundations is partnering with Reporting on Addiction to offer four microgrants ($500–$1,000 each) for journalists reporting in Kentucky, Maine, New Jersey and New York to investigate how opioid settlement funds are being allocated and spent.

Grants will support long-term reporting that help your audience understand the opioid settlements and show them where and how funds are being spent. Priority will be given to submissions focused on:

• Spending (or a lack of spending) related to evidence-based prevention, addiction, harm reduction, treatment and/or recovery.
• Issues with waste, fraud, abuse, or mismanagement of opioid settlement funds.
• Incorporating the perspectives of impacted community members.
• Helping communities understand the spending decision-making process (or lack of process).

Story pitch requirements: Pitches can be for any platform, print, digital, radio, television, podcast, etc. Freelancer submissions are welcome, but must have a letter of support from a publisher.

Grant awardees will receive free training: Awardees must agree to attend two virtual Reporting on Addiction trainings, share their final story, and have a commitment from a newsroom editor to publish their reporting by Feb. 1, 2026. Freelancers should secure a publication commitment before applying and supply supporting documentation.

Report: The national cost of opioid use disorder is in the trillions of dollars each year, in addition to the suffering

Axios map, from Avalere Health data

As counties across the U.S. see many types of illicit drug deaths decrease, the country is left to grapple with the long trail of complex problems drug addictions cause, including their massive price tags.

A newly released in-depth analysis "concludes that it costs an average of nearly $700,000 to treat each affected person," reports Maya Goldman of Axios. "The cost burden falls unevenly, with states in a belt stretching through Appalachia to New England typically having bigger caseloads and a higher cost per case."

Although it's not possible to pin down the exact net dollars the country spent on opioid use disorder, the analysis from Avalere estimated 2024 costs at $4 trillion." The report's author, Margaret Scott, told Goldman, "While this is a cost to government, it's also a cost to private businesses, and the huge cost, of course, is to the individuals who have" opioid use disorder.

Comparing regional expenditures illustrates how extreme the costs for treatment can be. "The projected cost of opioid use disorder in 2024 ranged from $419,527 per case in Idaho to more than $2.4 million in D.C.," Goldman explains. "That covers lost productivity, health insurance costs, property lost to crime and other variables."

The economic losses from OUD are second only to the degree of human suffering individuals, families and friends have experienced by way of OUD trauma. Some of the sobering estimated and reported costs include:

• Economic burden on patients, including years of life lost and reduced quality of life, exceeded $3 trillion in 2024.
• Private businesses absorbed more than $467 billion in costs from lost productivity and health insurance costs.
• The federal government bore about $118 billion in Medicare and other federal insurance costs, lost taxes and criminal justice expenses.
• It cost state and local governments more than $94 billion, with about $42 billion going toward criminal justice costs.
• The Trump administration in March released its own analysis that estimated illicit opioids cost the U.S. about $2.7 trillion in 2023.

One way to reduce opioid treatment costs is to offer individuals the most effective treatment combinations possible. "Behavioral therapy alongside long-acting injectable buprenorphine — a treatment that reduces the risk of future overdoses — generated an estimated $295,000 savings per case, the biggest cost-saver of the options Avalere analyzed," Goldman reports. "Behavioral therapy alone saves a project $144,000 per case."

To use Axios' interactive state map of costs, click here.

Class-action suit against The Salvation Army could help addiction sufferers access the two most effective medical treatment drugs

The Salvation Army is best known for
its holiday bell ringers. (Adobe photo)

Managing up to 25,000 Christmas bell ringers isn't the only thing The Salvation Army does. The charity also runs addiction treatment facilities whose care is at the "center of a legal fight that could set a precedent for all Americans seeking treatment for opioid addiction using two common and effective medications, methadone and buprenorphine," reports Lev Facher of STAT News.

The Salvation Army addiction facilities prohibit participants from using methadone and buprenorphine, despite the fact the "two medications are widely used to treat addiction and are vastly safer than the drugs they are meant to replace, like heroin or fentanyl," Facher explains. The class-action suit alleges its plaintiffs were "denied access to addiction treatment services because of their use of the medications."

The two drugs form the only medical treatment shown to effectively help addiction sufferers stop using opioids. The drugs also prevent severe fentanyl withdrawal, which can be physically and mentally excruciating.

Methadone and buprenorphine are often viewed by many Americans as "little better than street drugs," Facher reports. "As STAT found in the investigative series "The War on Recovery," many recovery-focused groups — including The Salvation Army and other rehabilitation centers, as well as 12-step recovery organizations like Narcotics Anonymous — remain opposed to the medications’ use despite the overwhelming evidence of their medical benefit."

Officials with The Salvation Army did not respond to requests for comments, according to Facher. 

Janet Herold, an attorney with the nonprofit Justice Catalyst Law, which sued The Salvation Army, told Facher, “The case has the potential to quite dramatically change the access situation for people with opioid use disorder." Facher adds, "The ongoing lawsuit, Herold said, could set a precedent that leads more treatment providers to offer the medications regardless of their ideological objections."

According to Facher's report, the "judge's ruling relies in part on the Rehabilitation Act of 1973, legislation that bars any group receiving federal financial assistance from discriminating against an individual solely on the basis of their disability."

A glimmer of hope for U.S. overdose deaths: They are at their lowest levels since 2020, but officials warn to press on

A snapshot of overdose deaths from January 2015 to January 2024
(CDC graph, based on data available for analysis)

The U.S. opioid epidemic isn't over, but national totals for overdose deaths have declined for 12 months in a row, with current numbers "slowed to the lowest levels since 2020," reports Alexander Tin of CBS News. The decrease in deaths is attributed to several factors; however, experts warn that now is a time to "double down" on current efforts and keep looking for new ways to prevent drug abuse from starting.

American overdose deaths peaked in 2023, but the latest trend offers hope and some reassurance that current treatments are saving lives. "Around 70,655 deaths linked to opioids like heroin and fentanyl were reported for the year ending June 2024, the Centers for Disease Control and Prevention now estimates, falling 18% from the same time in 2023," Tin writes. "Almost all states, except for a handful in the West from Alaska through Nevada, are now seeing a significant decrease in overdose death rates."

In Appalachian states, such as West Virginia, where opioid addiction among residents was disproportionately high, overdose deaths have steadily declined with the rest of the nation. Emily Rice of West Virginia Public Radio reports, "A Sept. 1 analysis of provisional overdose death rate data from the CDC shows a rapid decrease in the number of drug overdose deaths in the U.S. and this time West Virginia appears to be keeping pace."

Even with good news, the current rates remain grim. Dr. Allison Arwady, head of the CDC's National Center for Injury Prevention and Control, told Tin, "We are encouraged by this data, but boy, it is time to double down on the things that we know are working. It is not a time to pull back, and I feel very strongly, and our data shows, that the threat continues to evolve." Brian Mann of NPR reports, "Roughly 100,000 deaths are still occurring per year. . .fentanyl, methamphetamines, xylazine and other synthetic chemicals are more poisonous than ever."

But the roughly 10.6 percent decline in overdose fatalities still speaks to some success. Tin writes, "Arwady pointed to a long list of factors that officials hope are contributing to the decline, ranging from broader availability of the overdose-reversing spray naloxone, also known as Narcan, to efforts to ease gaps in access to medications that can treat opioid use disorder."

Youth education programs may be contributing to the decline. Tin explains, "Trends in what health officials call 'primary prevention' have also improved in recent years — meaning fewer people using the drugs to begin with. As an example, Arwady cited CDC surveys showing a clear decline in high school students reporting that they have tried illegal drugs."

Opinion: Understanding how fentanyl 'saturated the U.S. drug supply' could help address the addiction crisis

Naloxone can prevent overdose deaths, but it's expensive.
(Adobe Stock photo)

The current U.S. opioid crisis started with painkiller prescriptions in the early 2000s, but once medical providers started nixing those medicines, heroin's popularity surged, and then fentanyl and its "tsunami" of death entered the market, reports Maia Szalavitz of The New York Times. "Understanding how fentanyl saturated the drug supply, moving from the East Coast of the U.S. to the West, is critical to ending the worst drug crisis in American history."

Drug cartels' greed drove the creation and use of fentanyl. "By 2013, cartels had realized that they could slash their labor, manufacturing and transit costs by replacing heroin derived from farm-grown opium with a powder made in a lab — fentanyl," Szalavitz writes. "Before 2018, 80% of all deaths associated with fentanyl occurred east of the Mississippi. . . . Since 2021, at least two-thirds of America’s 100,000 annual overdose deaths involved a synthetic opioid like fentanyl."

While heroin was considered a more urban drug, "increased opioid prescriptions — followed by sharp reductions — resulted in new heroin users in rural areas," Szalavitz explains. "Illegally manufactured fentanyl began appearing in both urban and rural drug markets. . . . Rural West Virginia and other Appalachian regions were the center of the earliest prescription opioid wave of the crisis, which led to the establishment of new heroin markets in places facing job loss."

Combating opioid addiction and overdose deaths liked to fentanyl is tough because the drug's supply chain and use is now deeply embedded across the country. The drug is cheap to make and buy, and provides an exceedingly potent high for the user. "So, what can be done? The answer is to focus on the drivers of demand, not supply. This means addressing the roots of addiction and treating it compassionately," Szalavitz writes. "We have a great generic opioid overdose antidote, naloxone. . . . And two medications — methadone and buprenorphine — have proved to cut the risk of death among people with opioid addictions by 50% or more when used long-term."

Szalavitz adds that people often start doing drugs because their lives feel hopeless. "Addiction is most often an attempt to escape despair. The condition itself is defined by compulsive drug use despite negative consequences, which is why threats of punishment or even death rarely yield recovery. . . . It’s not coincidental that the exponential rise in overdose deaths has occurred in tandem with a profound increase in income inequality."

Some U.S. lawmakers want to change methadone treatment availability, but their plan's success seems unlikely

When it comes to substance abuse disorder, perhaps
there is 'no cure.' (Adobe Stock photo)

Solving the U.S. fentanyl overdose crisis has led to political discussions about decreasing methadone treatment restrictions. A recent proposal by a bipartisan group of U.S. senators seeks to save lives by "allowing addiction specialists to prescribe [methadone] outside of the clinics now permitted to dispense it," reports Carmen Paun of Politico. But the bill faces opposition from methadone clinic directors who maintain "that allowing prescribing outside of clinics is risky without their strict safeguards. Methadone is an addictive opioid that’s deadly if abused."

If passed, the bill "would reshape not only how methadone is prescribed but also dispensed — patients could pick up their prescription at the pharmacy," Paun explains. "Now, most have to go in person every day to a clinic to receive their dose under supervision." The additional time and expense of daily travel to and from treatment clinics can make recovery more difficult.

Conflicts over methadone are like a catch-22: "Proponents of making methadone easier to get say that [fentanly's death] toll is ample reason to rethink treatment rules that are now decades old," Paun reports. "The clinics fear it’s a bad idea that could make the overdose problem worse. Thus far, they’re winning the debate in the only forum that matters: Congress."

As the legislation stands now, it is not likely to become law, but the opioid problem remains. "The clinics have succeeded in convincing enough Republicans that expanded access comes with significant risks," Paun writes. "Advocates of broader prescribing say the clinics are more interested in protecting their turf than in saving lives. . . "

Even if methadone could be dispensed through the pharmacy model, the drug isn't a panacea. "Many of those who start methadone treatment drop out within the first year," Paun reports. "Only 34% of a sample of 39,000 patients at BayMark Health Services, one of the nation’s largest methadone treatment providers, were still in treatment one year after they started . . .The reality of opioid use disorder is that, for many, there is no cure, experts in the condition say. Rather, it’s a chronic condition needing lifelong medication and management."

California prosecutors charge fentanyl suppliers with murder. The legally unsettled approach is catching on.

Prosecutors in California are forging a path to make fentanyl dealers accountable for their part in overdose deaths by filing homicide charges against them. In Riverside County, California, county district attorney Mike Hestrin "has charged 34 suspected fentanyl suppliers with murder and is said to be the first prosecutor in California to achieve a guilty verdict from a jury in a fentanyl-related homicide trial," reports Michael Corkery of The New York Times. Some critics fault the prosecution of street dealers "as a misguided return to the aggressive approaches of the 1990s, which failed to curb drug use and swelled state prison populations."

But even in boldly liberal parts of the state, murder investigations of fentanyl overdoses are being used to discourage fentanyl sales and provide some level of justice for families. Corkery writes, "Some other counties — like San Diego and Placer, near Sacramento — that have also brought murder charges against fentanyl suppliers have sizable numbers of conservative-minded voters who tend to favor more punitive approaches to crime." Even in San Francisco, the district attorney's office is planning to prosecute fentanyl dealers for overdose deaths.

While prosecutors pursue murder charges against fentanyl dealers, their cases are on murky legal ground. "Prosecutors have been working around the fact that California does not have a law that specifically allows fentanyl deaths to be charged as murders," Corkery explains. 

Defense attorneys have responded to the prosecutions as "overbroad and unconstitutional," Corkery reports. But their complaints are being drowned out. "Parents whose children died from fentanyl are a driving force behind new laws and stepped-up prosecutions just as the parents of drunken-driving victims swayed the nation to crack down on alcohol-fueled traffic deaths decades ago."

To read more on how California prosecutors are using the Watson murder rule to prosecute fentanyl suppliers, click here. 

Drug Enforcement Administration statistics draw a startling picture of fentanyl's lethal power: It is the leading cause of death for Americans ages 18 to 45, and it's responsible for nearly 70 percent of the United States' 107,000+ drug overdose deaths in the past year. A educational warning video is shared below.

Investigative report examines where fentanyl comes from, how it's made and how it is spread throughout the U.S.

Fentanyl ingredients travel thousands of miles before
crossing into the U.S. (El País graphic)

In trying to encapsulate how much harm fentanyl has done to Americans, the Spanish daily newspaper El País has produced a detailed report, "Fentanyl: The Portrait of a mass murderer," by Iker Seisdedos, David Marcial, Pérez Carlos Rosillo, and Guillermo Abril. Their investigation looks at where fentanyl ingredients come from, where it is made and how it enters the United States.

They write, "It's a big threat. A cheap, white powder — 50 times more powerful than heroin — which kills more than 70,000 people each year in the United States and countless others across the rest of the Western Hemisphere. El País, in a long-term investigation that spanned two continents and included interviews with anti-drug czars in the U.S. and China, visited the clandestine laboratories in Sinaloa, Mexico, where fentanyl is manufactured."

They use as an example how the crisis has affected people in Philadephia. El País reports, "Hundreds of people who are addicted to the powerful opioid live and die on these streets. . . .The fate of all of them begins about 2,500 miles away, next to a different set of train tracks: those that cross Culiacán, in the heart of Mexican drug trafficking territory."

State of Sinaloa within Mexico
(Wikipedia map)

In Culiacán, the capital of the Mexican state of Sinaloa, a drug cartel makes "cuts" of fentanyl, which is tested on human "guinea pigs" until it is deemed potent enough to ship to the U.S. But while a "cook" in Mexico has created the batch of fentanyl, its chief ingredients, called precursors, were made in China. "A kilo of Chinese precursors costs the cartel — about $800," El País reports. "From there, four kilos of fentanyl come out. The profit can be between 200 and 800 times what they paid. That is, from $160,000 to $640,000 per kilo."

El País reports, "Fentanyl that enters the United States from Mexico comes in powder or, increasingly, in the form of fake pills, which are camouflaged as commercial brands such as Xanax, Vicodin or OxyContin. Drug traffickers press them with machines that they also buy from China."

The point of entry is the hardest for fentanyl traffickers. "According to U.S. authorities, more than 90% of fentanyl enters the country via official ports of entry, hidden in private vehicles or cargo trucks, In 2018 — according to data from Customs and Border Protection — 600 kilos of the substance were intercepted. In 2022, the amount rose to 7,200 kilos."

To read more in-depth about how cartels infiltrate the U.S., and China's involvement in fentanyl trade, click here.

Overdose-prevention programs in remote Maine work to stem drug-related problems and deaths

Naloxone is part of harm-reduction strategies.
(Photo by NEXT Distro, Unsplash)

Access to drug overdose prevention and addiction treatment in rural America can be almost non-existent. In Washington County, Maine, a remote area ravaged by drug use and overdose deaths, there was little help for substance-related issues. But a non-profit with federal dollars from the Substance Abuse and Mental Health Services Administration is working to change the county's number of drug-related medical problems and deaths, reports Taylor Sisk of The Daily Yonder. "In 2022, SAMSA awarded $30 million to 25 grantees to support community-based overdose-prevention programs, syringe services programs, and other harm reduction services. . . .MaineHealth received $1.2 million for a statewide overdose- and infection-prevention initiative."

Washington County, ME
(Wikipedia map)

Because Maine is small -- California is five times its size -- fewer people may know the extent of the state's drug problems. "Maine is the most rural state in the country with one of the highest drug-overdose rates. . . . It has one of the highest rates of acute hepatitis B. And it has the highest rate of hepatitis C, largely attributed to injection drug use," Sisk writes. "Washington County is the nation's easternmost county – the last stop on the line. It has a Walmart in Calais, the county's largest town, pop. 3,032. But if you live in Machias, the second largest town, pop. 2,062, it's an hour's drive. You're more likely to rely on the Family Dollar for your essentials. There's no bus service and one taxi company. . . . It has the highest poverty rate in the state."

In 2022, MaineHealth "launched Project DHARMA – Distribution of Harm Reduction Access in Rural Maine Areas – a collaboration with community-based organizations, including syringe services programs. Washington County became a beneficiary," Sisk reports. Harm reduction care "embraces a set of evidence-based strategies for reducing the negative consequences of drug use to keep people alive and as healthy as possible until such time as they should be ready to seek treatment."

Kinna Thakarar is an infectious disease and addiction medicine physician for MaineHealth and Project DHARMA's lead researcher. She told Sisk, "The services Project DHARMA is funding are evidence-based. Among the supplies and services syringe services programs typically provide in addition to clean syringes are saline, Band-Aids, condoms, information, and referrals. . . . They provide naloxone, a medication that quickly reverses the effects of an opioid overdose, and offer fentanyl test strips, an increasingly urgent need."

"Another critical service this grant will fund is one advocates have fought hard to launch: drug testing using handheld spectrometers. Outreach workers will test drugs to determine their contents; the drugs will then be sent to Colby College for confirmation. Other academic partners are providing technical assistance," Sisk writes. "But gaining permission to do so wasn’t easy. It required passing legislation 'so that none of us would get arrested in doing this evidence-based public health work,' Thakarar said. The passage of L.D. 1745, signed into law this summer, allows select individuals to possess 'nominal amounts' of illicit or controlled substances for the purposes of drug testing."

Drug overdose deaths don't just happen to adults; dozens of teens die each month, and boys are especially vulnerable

The U.S. continues to see overwhelming numbers of drug overdose deaths, but one of the most jarring statistics is the number of adolescents dying from overdoses every month, reports Ty Schepis for The Conversation, a journalistic platform for academics. "Drug overdoses are killing young Americans in unprecedented numbers: The monthly total rose from 31 in July 2019 to 87 in May 2021, the period with the most recent data. As a scholar of substance use who focuses on patterns that vary between age groups, I’m struck by how adolescents’ overdose deaths differ from adults’ in terms of gender, race and ethnicity and the drugs causing these fatalities."

The Conversation graph, from CDC data

Who is dying? "When the Centers for Disease Control and Prevention examined data for Americans 10 to 19 years old, it found that, as is the case for adults, most adolescents dying from drug overdoses are male. However, the share of girls among these fatalities is larger than the share of women," Schepis writes. "More than twice as many boys who are tweens or teens are dying of a drug overdose for every girl in that age group."

Which drug is most involved in teen overdose deaths? Fentanyl. "For teens, 84% of fatal overdoses involved fentanyl, and 56% of all overdoses involved only fentanyl," Schepis explains. "Many adolescents accidentally take fentanyl when they ingest counterfeit pills that they believe are prescription opioids or stimulants, or other illicit drugs that are laced with the drug. . . .In 67% of adolescent overdose deaths, a bystander was present who could have intervened. Naloxone was administered in less than half of cases where a bystander was present."

Is there a common thread among adolescent overdose deaths? Schepis reports, "Little or no prior drug use. Only 1 in 10 teens and tweens who died from a drug overdose had a history of treatment for a substance use problem, and only 1 in 7 had ever experienced a prior nonfatal overdose. . . . This pattern underscores the importance that all parents proactively talk with their children about substance use by the time they are 12 years old."

What can parents and extended family do to help change this pattern? "Having naloxone available can also be important. It prevents fentanyl and other opioids from causing an overdose by blocking access to opioid receptors in the brain," Schepis writes. "Think of naloxone like car insurance: You don’t want to use it, but it’s important to have in case something goes wrong. . . . There’s also a strong link between mental health conditions and drug overdoses among adults. . . . I recommend that all adults – whether caregivers or other people in an adolescent’s life – check in on their mental health regularly and recommend or seek treatment for any concerns as early as possible."

Newly released data reveals a 'virtual opioid belt' developed over about 15 years in West Virginia, Virginia and Kentucky

Average number of pills distributed per person per year, ranked by county from 2006 to 2019. White is equal to zero pills and scarlet is 120+ pills; shades of pink are ranges between those two. (Post via Openmap, with DEA Automation report data)

America's battle with pain-pill prescriptions might be tapering off, but deaths spawned by its spin-offs, heroin and fentanyl, have increased, and deeply affected regions are still clawing toward a recovery.

A database maintained by the Drug Enforcement Administration shows how the use of pain pills increased dramatically, particularly in Appalachian counties. The database "tracks every single pain pill sold in the United States, tracing the path from manufacturers and distributors to pharmacies in every town and city," reports Steven Rich, Paige Moody and Kevin Schaul of The Washington Post. "These records provide an unprecedented look at the surge of legal pain pills. . . which resulted in more than 210,000 overdose deaths during the 14-year time frame ending in 2019. It also sparked waves of an ongoing and raging opioid crisis first fueled by heroin and then illicit fentanyl."

The information can help people "understand the impact of years of prescription pill shipments on their communities," the Post reports. "A county-level analysis shows where the most oxycodone and hydrocodone pills were distributed across the country over that time — more than 145 billion in all."

The DEA's database, known as ARCHOs, was not willingly shared with the public. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, "waged a year-long legal battle for access to the database, which the government and the drug industry had sought to keep secret," Rich, Moody and Shaw add. "The initial release of data covered 2006 to 2012, and was later updated through 2014. . . . The Post analysis shows that the volumes of the pills handled by the companies climbed as the epidemic surged, increasing by 52 percent from 8.4 billion in 2006 to 12.8 billion in 2011."

Appalachian counties have maintained that their regions were targeted by pharmaceutical companies' greed. The maps show how those areas suffered more than other areas of the country. The Post reports, "Comparing county-level maps of prescription opioid overdose deaths and pill shipments reveal a virtual opioid belt of more than 90 counties stretching southwest from Webster County, W.Va., through southern Virginia and ending in Monroe County, Ky. This swath includes 18 of the top 20 counties ranked by per-capita prescription opioid deaths nationwide and 15 of the top 20 counties for opioid pills distributed per capita."

The maps show a 'virtual opioid belt' through Appalachia. (Post map, from DEA and CDC data)

Overdose is now the No. 1 cause of death for people under 40 in most states. Street fentanyl is mostly to blame

 

In most states, the number of Americans under 40 who died from accidental drug overdoses has exceeded any other cause of death. "It's now the top cause in 37 states," a new Stateline analysis shows. Death rates for Americans under 40 "were up by nearly a third in 2021 over 2018, and last year were still 21% higher," reports Tim Henderson of Stateline. "Covid-19 was a small part of the increase, causing about 23,000 deaths total between 2018 and 2022 in the age group. . . . Vehicle accidents and suicide (about 96,000 each) and gun homicide (about 65,000) all took a cumulative toll from 2018 to 2022, according to a Stateline analysis of federal Centers for Disease Control and Prevention data. . . . Overdose deaths, however, took almost 177,000 lives in that time."

A lethal dose of fentanyl
(FDA fentanyl fact sheet photo)

The number of unintentional overdose deaths shows fentanyl's deadly presence in U.S. street drugs. The "fresh wave of overdose deaths is different from the first three," Henderson writes, . . ."driven by drugs spiked with powerful fentanyl." Daliah Heller, vice president of drug use initiatives at Vital Strategies, an international advocacy group that works on strengthening public health, told Henderson: "Somebody might think they're getting a Xanax [for anxiety], or methamphetamine or cocaine. . . They have no experience with opioids; it's not what they're expecting, and now they have a much higher risk of overdose and death." According to the Food and Drug Administration, fentanyl is approximately 100 times more potent than morphine and 50 times more potent than heroin.

To lessen fentanyl's impact, states "are responding with 'harm reduction' strategies that can include warning of the new danger of recreational drugs laced with deadly fentanyl, training and equipping people to counteract overdoses when they see them," Henderson explains. "Nationally, accidental overdoses dominated the increase in deaths in residents under 40 across racial and urban-rural divides, but many disparities exist. The increase in young overdose death rates was 154% for Black Americans, 122% for Hispanic residents and 37% for white people, yet even for white residents, they represented the largest increase. . . The largest urban areas saw increases in overdose death rates of 70%, and rural areas 64%—the largest increases in both areas for any cause of death."