By Pat Anson, PNN Editor

Opioid overdose deaths fell by nearly 5 percent in 25 U.S. states last year, according to a new analysis from the Centers for Disease Control and Prevention -- one of the first reports to document a significant decrease in opioid overdoses.

The 25 states covered in the report are participating in the CDC’s State Unintentional Drug Overdose Reporting System (SUDORS), which tracks overdose deaths through toxicology, medical examiner and coroner reports. SUDORS is considered more reliable than other databases because it provides more details on the types of drugs involved – both legal and illegal.

Opioid overdoses fell overall by 4.6% in the first six months of 2018, driven in large part by a 6.6% decline in deaths involving prescription opioids. The CDC found that less than a third (28.7%) of the overdoses were linked to opioid pain medication. Most overdoses involve illicit drugs.

“Prescription opioid deaths stabilized nationally from 2016 to 2017, and the number of opioid prescriptions filled has been decreasing for several years, as efforts to reduce high-risk prescribing have increased. Findings from this report suggest these efforts might have fostered decreases in prescription opioid deaths without illicit opioids,” researchers said.

While the data about prescription opioids is encouraging, the report paints a grim picture about the abuse of other substances. Nearly 63% of the opioid overdoses involved a non-opioid drug such as cocaine, methamphetamine or benzodiazepines.

Overdoses linked to illicitly manufactured fentanyl (IMF) rose by 11.1% in 2018, with fentanyl or a fentanyl analog involved in nearly nine out of ten opioid deaths.

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine. Fentanyl analogs such as carfentanil can be even stronger. Most drug users have no idea what they’re getting, because fentanyl is often added to heroin, cocaine and other drugs to boost their potency, or used in the production of counterfeit medication.

Fentanyl Dominates Black Market

A new report from the RAND corporation, a nonprofit research organization, suggests the fentanyl problem will be hard to eradicate. Researchers looked at synthetic opioid markets in the U.S. and other parts of the world, such as Canada and Estonia — where fentanyl first appeared 20 years ago..

“Once fentanyl gains a foothold, it appears capable of sweeping through a market very quickly,” wrote Bryce Pardo, lead author of the study and an associate policy researcher at RAND. “We know of no instance in which fentanyl attained a dominant position in the marketplace and then lost that position to another less potent opioid. To date, fentanyl’s spread appears to be a one-way ratchet.

“One of the most important — and depressing — insights in this analysis is that however bad the synthetic opioid problem is now, it is likely to get worse before it gets better.” 

RAND researchers say the surge in fentanyl and other synthetic opioids is driven by supply-side factors more than user demand. China's pharmaceutical and chemical industries are poorly regulated, allowing producers to cheaply produce fentanyl and ship it to buyers anywhere in the world. Mexican drug traffickers smuggle most of the fentanyl that enters the U.S., although some of it is shipped in the mail or by commercial delivery services.

Unconventional strategies may be needed to address the fentanyl crisis. The RAND researchers advocate several innovative approaches, such as supervised drug consumption sites, creative supply disruption, drug product testing, and heroin-assisted treatment, which is available in some countries. Sweden has developed an online market with fentanyl analogs sold primarily as nasal sprays.

"It might be that the synthetic opioid problem will eventually be resolved with approaches or technologies that do not currently exist or have yet to be tested," said Beau Kilmer, study co-author and director of the RAND Drug Policy Research Center. "Limiting policy responses to existing approaches will likely be insufficient and may condemn many people to early deaths."

RAND researchers say there is little reason to believe that tougher sentences, including homicide laws for low-level drug dealers and couriers, will make a difference.

Last week the Mexican navy found over 25 tons of powdered fentanyl on a Danish ship docked at a Mexican port, one of the largest fentanyl shipments ever seized. The shipment originated from Shanghai, China.

Chinese officials are pushing back on claims that they’re not doing enough to stop fentanyl exports, saying the U.S. needs to stop blaming other countries for its own drug problems.

“A small group of people produce fentanyl illegally in China and mail them to the U.S. and other regions, driven by the exorbitant profit and at the request of criminals overseas, including those in the U.S. The Chinese government has zero tolerance for this. Once we find clues, we chase them down and spare no one,” Liu Yuejin, deputy head of the China National Narcotics Control Commission, told Bloomberg.

“I think the most important thing for U.S. politicians is to face the reality: What’s the root cause of such large-scale abuse of fentanyl in the U.S.? They need to find out and come up with solutions.”