How America’s opioid epidemic could get even worse

Summary and Analysis

This article is based on a large Rand Corporation report, The Future of Fentanyl and Other Synthetic Opioids, which concludes the following: 

"... (1) fentanyl and other synthetic opioids are becoming dominant in some parts of the United States and Canada, but remain less common in other parts of these countries; (2) a confluence of factors, including the dissemination of simplified and novel synthesis methods and increasing e-commerce, helps explain the surge in synthetic opioids; (3) much can be learned from other countries' experiences with synthetic opioids; (4) supplier decisions, not user demand, drive the transition to fentanyl; (5) fentanyl's spread is episodically fast and has ratchet-like persistence; (6) synthetic opioids drive up deaths rather than the number of users; (7) problems with synthetic opioids are likely to worsen before they improve, and states west of the Mississippi River must remain vigilant; (8) improving surveillance and monitoring is crucial; and (9) limiting policy responses to existing approaches seems unlikely to reverse this tide."

Excerpted from Vox

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The latest news on America’s opioid epidemic seems positive: Based on preliminary data, drug overdose deaths may have fallen in 2018 — for the first time since the crisis began in the 1990s.

But a new, exhaustive report by RAND, led by researcher Bryce Pardo, points to one way the opioid crisis could still take a turn for the worse, possibly leading to thousands more deaths each year, if the market for fentanyl were to become more widespread.

The report documents the rise of the synthetic opioid fentanyl and its analogs, which have increasingly been mixed with — or outright replaced — heroin and opioid painkillers in the illicit drug market. This trend toward fentanyl is known as the third wave of the opioid crisis, following the first wave of prescription opioids and the second wave of heroin.

The trend has led to a steep increase in overdose deaths, because fentanyl and its analogs are far more potent than other illicit opioids, and they’re a less-known quantity than heroin, making it hard for people who use opioids to properly calculate a safe dose. RAND’s report finds the introduction of fentanyl doesn’t increase the number of people who use opioids — the past decades’ increase continues to be linked primarily to the proliferation of painkillers — but instead increases the number of overdose deaths.