From pills to fentanyl: The evolution of America’s opioid crisis

America’s opioid crisis is no longer confined to prescription pills or heroin. The emergence of illicit fentanyl has transformed the landscape, creating a shadow epidemic that federal surveys have largely missed.

A recent study by RAND and the University of Southern California (USC) now brings the true scope of the crisis into sharper focus, revealing illicit opioid use rates that far exceed federal estimates.

Fentanyl use is higher than reports

For years, the National Survey on Drug Use and Health (NSDUH) has served as the cornerstone for tracking substance use in the United States.

In 2022, it reported that only 0.3% of adults had used illicitly manufactured fentanyl. RAND and USC’s findings, however, paint a vastly different picture. Between June 10 and June 17, 2024, researchers surveyed 1,515 adults using an anonymous online platform.

The results stunned the research team. Eleven percent of respondents admitted to using illicit opioids in the past 12 months. Fentanyl use stood at a staggering 7.5 percent.

“Estimates of illicit opioid use are rare and typically are available only years after the information is collected, limiting our ability to monitor trends on a near-term basis,” said David Powell, lead author and senior economist at RAND.

Patterns of fentanyl use

The study delved deep into demographic patterns, uncovering trends that federal surveys often overlook. Black respondents reported significantly higher rates of illicit opioid use, with their usage exceeding that of other racial groups by 6.6 percentage points.

Hispanic respondents also reported elevated rates of illicit opioid use, 5.5 percentage points higher than their counterparts.

Young adults aged 18 to 34 emerged as the most vulnerable group, with their likelihood of using fentanyl surging by 21.4 percentage points compared to those who were 55 and older.

Hidden fentanyl crisis

The RAND-USC study diverged from the federal norm in its methodology. Instead of face-to-face interviews, the researchers opted for anonymous online surveys. This approach stripped away social desirability bias, and potentially encouraged more honest responses.

The distinction between intentional and unintentional use provided fresh insights. Among respondents, 7.7% admitted to intentional non-prescription opioid use.

Another 3.2% of respondents said they may have used opioids unintentionally – a crucial finding given fentanyl’s pervasive presence in other drugs.

Prescriptions and illicit fentanyl use

The journey into opioid misuse often starts with a prescription. Among those reporting illicit opioid use, 39% said their first exposure involved prescribed opioids. Another 36% initially took prescription opioids that weren’t theirs.

The remaining 25% began with illicitly manufactured opioids. Fentanyl users followed a similar pattern, with 40% starting with prescribed opioids, 33% with unauthorized prescriptions, and 26% with illicit fentanyl.

“Ultimately, the data presented here should be treated as a substantive data point for understanding and curtailing the ongoing opioid crisis,” noted Mireille Jacobson, the study’s co-author and an economist at USC.

Fear of deadly consequences

Respondents voiced growing fears about the risk of overdose. While 4.7% of the overall sample considered an overdose very likely, that number spiked to 24% among those who had used fentanyl.

Among those who reported unintentional fentanyl use, 33% felt a fatal overdose was likely. These findings underscore fentanyl’s deadly potency. Even a slight miscalculation can mean the difference between life and death.

Limitations of the study

No study is without its flaws, and the RAND-USC survey is no exception. By relying on an online platform, the study may have excluded populations without internet access, potentially skewing the sample.

Self-reported data always carries a risk of underreporting or overreporting, especially regarding stigmatized behaviors like drug use. The study also didn’t account for other substances, such as stimulants or benzodiazepines, which frequently contribute to polysubstance overdoses.

Despite its limitations, the study offers a cost-effective model for real-time monitoring of opioid use. Traditional surveys take years to compile and analyze, leaving public health officials scrambling to respond to outdated data.

“Our study offers a method to quickly and repeatedly monitor illicit opioid prevalence at low cost,” noted Powell.

Extent of the opioid crisis

The opioid epidemic shows no signs of abating. With fentanyl flooding the illicit drug market, overdose deaths continue to climb. Yet, traditional surveys remain slow and outdated, and fail to capture the crisis’s true scope.

The RAND-USC study provides a chilling glimpse into the magnitude of the problem. By adopting more agile and anonymous data collection methods, researchers can finally expose the full extent of illicit opioid use in the United States.

Until then, fentanyl will remain a lethal wildcard in America’s ongoing opioid crisis that continues to claim lives at an alarming rate.

The research received support from Arnold Ventures and the National Institute on Drug Abuse under award numbers R21DA06011 and 2P50DA046351-06A1. The content, however, solely reflects the authors’ findings and does not necessarily represent the views of these organizations.

The study is published in the journal JAMA Health Forum.

—–

Like what you read? Subscribe to our newsletter for engaging articles, exclusive content, and the latest updates. 

Check us out on EarthSnap, a free app brought to you by Eric Ralls and Earth.com.

—–