Fentanyl Drug Submissions Level Off in 2017 but Rise in the South and West

This report looks at fentanyl in drug samples seized by law enforcement through 2017, using preliminary data. It describes the start of a possible plateau at that time, not the years since.

In 2017 the United States recorded 70,237 drug overdose deaths. Of these, 47,600 (67.8%) involved an opioid, and 28,466 (40.5%) involved a synthetic opioid other than methadone, such as fentanyl or tramadol. From 2013 through 2017, the steadily growing supply of illicitly manufactured fentanyl (IMF) drove large increases in deaths from those synthetic opioids.

Fentanyl is 50 to 100 times more potent than morphine and is legally prescribed for pain. IMF is sold on its own, as a powder or pressed into counterfeit pills, or mixed with or sold as heroin or cocaine. One way to track how much IMF is circulating is to count "fentanyl submissions": drug products obtained by law enforcement, sent to laboratories for testing, and found to contain fentanyl. Most of these are IMF. Those counts had climbed rapidly, especially in the Midwest and Northeast.

What the data showed

CDC researchers analyzed preliminary data from laboratories in the Drug Enforcement Administration's National Forensic Laboratory Information System, comparing half-year periods (January–June and July–December) from 2010 through 2017.

Number of drug products seized by law enforcement that tested positive for fentanyl, by half year, United States, 2010–2017. CDC.

• Starting in the first half of 2013, fentanyl submissions rose an average of 87% from one half year to the next (range 10% to 317%).
• Between the first and second halves of 2017, they fell 2%, from 29,344 to 28,826.

The dip appears to have come from states with high numbers of submissions. Ohio, Pennsylvania and Massachusetts together accounted for 48% of all fentanyl submissions in the first half of 2017, and they saw an average decline of 13% in the second half:

Over the same months, submissions rose 8% in the South (5,883 to 6,341) and 36% in the West (547 to 743). The largest increases were in South Carolina (216 to 428, up 98%), Florida (674 to 850, up 26%) and Virginia (942 to 1,097, up 16%) in the South, and in California (269 to 386, up 43%) and Arizona (137 to 226, up 65%) in the West.

Deaths slowed too

Ohio, Pennsylvania and Massachusetts were among the first states to see sharp increases in fentanyl submissions and overdose deaths in 2013–2014. An earlier report found that changes in fentanyl submissions and in overdose deaths were positively correlated, and the pattern held here. Deaths involving synthetic opioids other than methadone rose 4% between the first and second halves of 2017 (13,986 to 14,480), compared with an average rise of 34% (range 7% to 69%) per half year since early 2013.

Reasons for caution

The authors called the findings encouraging but warned against reading too much into them:

• The trend rests on a short span of time and might not last.
• Submissions may have peaked in the states hit first, but they were rising in other states in the South and West.
• Even if fentanyl submissions stayed level, other emerging synthetic opioids, such as fentanyl analogs, could keep pushing overdose deaths up.
• The counts are preliminary. Testing takes time, so the most recent figures, especially for late 2017, might rise slightly once the DEA releases updated data.

They pointed to strategies aimed at people at high risk of an illicit opioid overdose, including wide distribution of naloxone and better linkage to care, as effective ways to reduce overdose deaths.

Sources

• Springer YP, Gladden RM, O'Donnell J, Seth P. Notes from the Field: Fentanyl Drug Submissions — United States, 2010–2017. MMWR Morb Mortal Wkly Rep 68(2). https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a4.htm
• Drug Enforcement Administration, National Forensic Laboratory Information System, fentanyl brief for 2017: https://www.nflis.deadiversion.usdoj.gov/DesktopModules/ReportDownloads/Reports/NFLISFentanylBrief2017.pdf