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NIH Record - 75th Anniversary - National Institutes of Health

Research Shows Dangerous, Growing Trend of Illicit Fentanyl Use

graph plotted with number of pills containing fentanyl

The number of pills containing fentanyl seized by law enforcement increased dramatically in the U.S. between 2018-2021.

Photo: NIDA

Law enforcement seizures of pills containing illicit fentanyl increased dramatically since 2018, according to a new NIDA-funded study published in Drug and Alcohol Dependence

The number of individual pills seized increased nearly 50-fold from the first quarter of 2018 to the last quarter of 2021, and the proportion of pills to total seizures more than doubled by the end of 2021. 

The latest CDC data shows the U.S. hit a record high in overdose deaths, estimating that nearly 106,000 people died from drug overdoses in the 12-month period ending in October 2021. This rise is largely driven by illicit fentanyl and other synthetic opioids. 

Illicit fentanyl is highly potent, cheaply made and easily transported, making it a profitable narcotic. While people may seek out illicit fentanyl intentionally, many people are not aware the drug they are using—including heroin, cocaine, methamphetamine or benzodiazepines—may actually be fentanyl, or was contaminated with it. Because fentanyl is about 50 times more potent than heroin and a lethal dose may be as small as 2 mg., using a drug laced with fentanyl greatly increases overdose risk.

To ascertain the extent that fentanyl is found in counterfeit pills, a research team led by Dr. Joseph Palamar of the NYU Grossman School of Medicine and co-investigator on the NIDA-funded National Drug Early-Warning System, analyzed data on drug seizures by law enforcement. The data were collected from the High Intensity Drug Trafficking Areas (HIDTA) program in which the Drug Enforcement Administration and CDC play an active role. 

“We absolutely need more harm-reduction strategies, such as naloxone distribution and fentanyl test strips, as well as widespread education about the risk of pills that are not coming from a pharmacy,” said Palamar. “The immediate message here is that pills illegally obtained can contain fentanyl.”

HIDTA data are made available quarterly, allowing evaluation in almost real time. Analyzing these data can therefore help identify trends in availability of illicit substances and act as an early-warning system to shift public health education or interventional resources more quickly.

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