CDC Identifies the Drug Responsible for the Most Overdose Deaths in the US

The past decade has seen opioid overdose deaths skyrocket in the US, and public health officials report that one drug is largely responsible: fentanyl. The ultra-potent synthetic opioid has been used in healthcare settings since the Sixties, and it’s even on the World Health Organization’s Essential Medicines List for treating cancer pain, but the US Centers for Disease Control and Prevention reported on Wednesday that fentanyl is now the drug responsible for the most overdoses in the US, ahead of heroin, cocaine, methamphetamine, and well, literally every other drug.

In a study published in the CDC’s National Vital Statistics Report, officials outline how the drug went from the 10th deadliest in 2011 to number one in 2016. The report also shows just how much overdose deaths in the US have gone up. In 2011, oxycodone caused the most overdose deaths, 5,587. Then in 2016 the leader, fentanyl, caused more than three times that amount, with 18,335 deaths

The rate of increase is made crystal clear by the CDC’s data: The number of fentanyl overdoses in the US doubled each year from 2013 to 2016.

In 2011, fentanyl was responsible for 1,662 overdose deaths in the US, about 4 percent of that year’s death toll. In the subsequent years, it moved steadily up the list: ninth place in 2012 and 2013, fifth in 2014, then second in 2015 — just behind heroin. In 2016, the most recent year for which complete data are available, fentanyl was responsible for 28.8 percent of the country’s overdose deaths.

For anyone who’s followed news of the US opioid overdose crisis, this report’s findings may not come as a huge surprise, as fentanyl has become a central point in political and public health discussions about the crisis. In March, the CDC attributed recent increases in opioid overdose deaths to illicit fentanyl. This summer, then-Attorney General Jeff Sessions blamed China and the dark web for fentanyl’s explosion in the US. And in December, President Donald Trump asked Chinese President Xi Jinping to crack down on fentanyl coming to the US from China. And this focus isn’t just political. It’s based in data and intelligence.

A DEA spokesperson told Inverse in August that the Mexican drug cartels who used to sell heroin in the US have transitioned to fentanyl. Their suppliers of heroin manufacturing chemicals, based in China, followed suit and began sending fentanyl instead. This shift is reflected in the CDC’s data, as fentanyl traded places with heroin and surpassed its death toll.

Due to these changes in the international black market, as well as advances in illicit drug production — instructions for fentanyl manufacturing are readily available online in reputable academic journals — more and more of the substance has found its way onto the streets. Drug users who buy heroin, cocaine, or counterfeit pharmaceuticals cut with fentanyl are especially susceptible to overdose because they don’t know the potency of what they’re buying — oftentimes, they don’t even know there’s fentanyl in their drugs at all.

“You just don’t have any idea what you’re going to get. You don’t know what’s in it. Anybody can take white powder, press it into pill form, and put a little brand on it,” DEA spokesperson Rusty Payne told Inverse in August after Demi Lovato’s highly publicized overdose, which involved counterfeit pills containing fentanyl. But it’s not just that fentanyl has replaced other opioids as the deadliest drug in the US. It’s killing more people than heroin or oxycodone ever did.

Between 1999 and 2016, the number of overdose deaths from all drugs in the US more than tripled, and a significant portion of that blame lies on illicit fentanyl, though it’s not alone. The CDC report notes that cocaine has consistently stayed in second or third place for overdose deaths.

The CDC’s data offer no solutions, as the report is meant to centralize and clarify a set of numbers, rather than offer explanations. And while the numbers seem grim, advocates are not short on possible solutions.

Medication-assisted therapy, safe consumption sites, and housing programs are among the most promising initiatives that public health researchers have proposed to help stem the tide of opioid overdose deaths in the US.