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Fentanyl Abuse Statistics: Rates, Overdose & Trafficking

Elena Hill, MD, MPH profile image
By Elena Hill, MD, MPH • Updated Nov 7, 2023 • 14 cited sources

Fentanyl is an extremely potent synthetic opioid that is 50 to 100 times stronger than morphine.[1]

In 2020, over 350,000 people in the United States reported misusing prescription fentanyl products [2]. This does not include the even greater number of individuals using fentanyl illegally. 

One of the dangers of Fentanyl is that it is commonly mixed into elicit heroin or counterfeit oral painkillers. Fentanyl can be fatal with just one use. Therefore, users of illicit opioid drugs may not even know they are ingesting fentanyl until it is too late. 

Misuse rates of fentanyl are likely underreported because people do not always even know that the drug they are taking contains fentanyl. 

A rising number of overdose deaths have been attributed to fentanyl in recent years. 

What Is Fentanyl?

Fentanyl is a “synthetic” opioid. This means that it is made in a lab and is not a derivative of the opioid/poppy plant. Unlike heroin, it does not come directly from the opium poppy plant. 

Fentanyl acts similarly to other opioids; however, it is much stronger and more potent. Fentanyl is a prescription painkiller used almost exclusively in the hospital. It is classified as a Schedule II controlled substance due to its high potential for abuse, diversion, dependence, addiction, and fatal overdose.[3] 

Fentanyl can be abused by smoking, snorting, injecting, or ingesting the drug.

Like other opioids, fentanyl makes changes to brain chemistry, creating a euphoric “high” and a sense of calm and relaxation. It is a central nervous system depressant, so it slows down heart rate, breathing, and blood pressure while lowering body temperature. 

The drug binds to opioid receptors in the brain and blocks pain sensations. It is often prescribed for breakthrough pain in cancer patients who require around-the-clock pain management and to those who are opioid-tolerant, so less potent opioids are not effective for them. 

The potency of fentanyl makes it highly dangerous in very small doses. The fact that the drug is often mixed into other opioids can increase the risk of an unintentional, life-threatening overdose. 

Fentanyl is also highly addictive. It causes difficult withdrawal symptoms and cravings, making the drug hard to stop using sometimes even after only a single use.

Stats on Fentanyl Misuse

Fentanyl misuse is difficult to quantify, as the drug is often used unknowingly by users of other illicit drugs like heroin and cocaine. 

Pharmaceutical fentanyl can be diverted. The prescription drug was reported to be misused by more than 350,000 people in the United States in 2020 [2]. Illicit fentanyl is likely misused at much greater rates, however. 

Overdose death rates: Overdose rates have been steadily increasing with the rise of fentanyl and other synthetic opioids in recent years. Fentanyl deaths account for more than half of all opioid overdose deaths.[4] This makes up close to three-quarters of all drug overdose deaths in the United States.

Fentanyl misuse commonly impacts individuals who regularly use illicit drugs, such as heroin and cocaine.[5] The drug impacts people of all ages, races, genders, and socioeconomic backgrounds. 

Fentanyl Statistics by State

Between April 2005 and March 2007, most fentanyl-involved overdose deaths occurred in the following states:[6]

  • Delaware
  • Illinois
  • Maryland
  • Michigan
  • Missouri
  • New Jersey
  • Pennsylvania

In 2015, the majority of fentanyl encounters occurred east of the Mississippi River with the highest level of fentanyl supply found in Ohio, New Hampshire, and Massachusetts.[8]

More recent data from 2020 reveals the following trends in fentanyl related overdoses:

Fentanyl-involved overdoses rose 93% in western states in 2020 compared to the previous year

In Southern states, there was a 64.7% increase in overdoses. 

In the midwestern states, there was a 33.1% increase in overdoses. 

Rates of fentanyl related overdose remained relatively stable in the northeastern states. [7]

In most regions, fentanyl-involved overdose deaths included mixing of multiple illicit substances, including cocaine (25.5%–35.1%) or heroin (16.6%–22.3%) except in the West where methamphetamine (25.3%) and prescription opioids (12.0%) were more commonly involved. 73% of the fentanyl associated deaths were male. In the western states, 21.8% were under the age of 25.[7] 

Injection of fentanyl was the most common method of misuse in every region except in the West where snorting, smoking, and ingesting the drug were more common. 

Why Has Fentanyl Become so Prevalent?

There are several reasons why fentanyl has risen in popularity. Fentanyl is often cheaper to manufacture than heroin as it is entirely synthetic/can be made in the lab without requiring  access to the poppy plant itself.

It can be delivered and trafficked in smaller doses. This can make it easier to hide and transport. It can also be combined with other drugs to make them more potent.

With the surge of opioid addiction in the United States, more people are dependent on these drugs and looking for something stronger. Beginning in 2013, a third wave of opioid overdose death rates began to climb involving synthetic opioids, largely driven by the increased popularity of fentanyl. This trend continues today.[9]

Statistics on Fentanyl Overdoses

The risk for overdose with even one use of fentanyl is extremely high. Death rates related to synthetic opioids which includes fentanyl and fentanyl analogs, rose 16% between 2018 and 2019. In 2019, rates were 12 times higher than in 2013.[10] 

In 2019, 36,000 people died from an opioid overdose in the United States. Overdose deaths continued to climb in 2020 (56,515 people died from a synthetic opioid overdose, the majority of which involved fentanyl).[11] 

Opioid overdose death rates accounted for the majority of the 68,630 opioid overdose fatalities in 2020 with rates increasing six-fold from 2015, mostly related to fentanyl. [11] 

Opioid overdose deaths made up around 70% of all drug overdose deaths in the United States in 2020, with synthetic opioids like fentanyl being the main culprit. Most (45%) fentanyl-involved overdose deaths include another drug, most often cocaine or heroin.[10]

Fentanyl can be deadly in extremely small doses — as small as 2 mg. Between January 30, 2020, and January 31, 2021, fentanyl was the main cause of drug overdose deaths, rising by 55.6%.[12] The DEA tested counterfeit pills and found that 42% contained a potentially lethal dose of at least 2 mg..[12]

One teaspoon of fentanyl is equal to 5 grams. The following chart details just how dangerous fentanyl is even in small quantities:

The actual amount of fentanyl it takes for overdose is hard to predict, and will depend on the individual, their metabolism and opioid tolerance, and if the fentanyl is mixed with other drugs.

Fentanyl Regulation 

Fentanyl is a tightly controlled narcotic that is in the highest drug schedule for a prescription medication. It is so potent that it is essentially only used intravenously in the hospital in situations where extreme pain management is required. Schedule II drugs are under strict regulations. Only illicit drugs with no accepted medical use, such as heroin, are more restricted. 

Illicit fentanyl use is illegal. There are strict penalties for possessing, selling, or using this drug for recreational purposes.

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Fentanyl Manufacturing & Trafficking

Today, the majority of illicit fentanyl is manufactured in Mexico.[13] In the past, it was more commonly manufactured in China and often sent in the mail or shipped overseas. Now, it is made in labs and pressed into counterfeit pills or mixed with other drugs, such as heroin, cocaine, or methamphetamine.

In 2019, there were 886 fentanyl drug trafficking cases.[14] While this only represents a small percentage of the federal drug trafficking caseload at just under 6%, these cases accounted for nearly three-quarters of all drug trafficking offenses that  led to serious bodily injury or death.

Nearly half (45.5%) of all fentanyl offenders trafficked another drug — heroin (59.8%) and cocaine (35.5%) primarily. Close to a third of fentanyl is sold as a different drug.[14] 

In 2018, approximately 108,015, or 34%, of all illicit pills seized in the United States and tested by the DEA contained fentanyl or a fentanyl analog.[14]

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Statistics on Fentanyl Addiction & Treatment

Close to 3 million Americans had an opioid use disorder (OUD) in 2020. Fentanyl is a highly addictive drug and commonly combined with other drugs. This can increase the rate of addiction and potential complications. 

In 2020, approximately 2.6 million people received treatment for illicit drug use. In addition, 30.5%, or close to 800,000 people, received Medication-Assisted Treatment, or MAT.[2]

MAT is an evidence-based treatment method that is highly successful in treating opioid use disorder (OUD). It uses medications to reduce cravings and withdrawal symptoms associated with OUD. 

The use of MAT can help to lower the risk for fentanyl overdose deaths and illicit opioid use. MAT can help to regulate the brain chemistry that is involved in opioid dependence and aid in balancing out the physical and emotional complications associated with fentanyl dependence and addiction.

While addiction treatment and MAT can greatly improve rates of recovery, only 6.5% of people who needed treatment for any substance use disorder in 2020 received the necessary help in a specialized facility.[2] 

The Importance of MAT

Fentanyl is an extremely dangerous drug with high rates of addiction and overdose fatalities. MAT can be lifesaving. It can help to keep individuals in treatment and minimize the odds of a potentially fatal relapse and unintentional overdose. 

By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. Fentanyl DrugFacts. National Institute on Drug Abuse (NIDA). June 2021. Accessed April 2022. 
  2. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). October 2021. Accessed April 2022.
  3. Controlled Substance Schedules. Drug Enforcement Administration (DEA). Accessed April 2022.
  4. NLFIS-Drug 2020 Annual Report. National Forensic Laboratory Information System (NFLIS). 2020. Accessed April 2022.
  5. Fentanyl and COVID-19 May Have Made the Opioid Epidemic Even Deadlier. Time.  December 2021. Accessed April 2022.
  6. Fentanyl. Drug Enforcement Administration (DEA). September 2019. Accessed April 2022.
  7. Trends and Characteristics of Drug Overdose Deaths Involving Illicitly Manufactured Fentanyls – United States, 2019-2020. Centers for Disease Control and Prevention (CDC). December 2021. Accessed April 2022.
  8. Fentanyl Encounters Data: 2015 Rate Map. Centers for Disease Control and Prevention (CDC). July 2019. Accessed April 2022.
  9. Understanding the Epidemic. Centers for Disease Control and Prevention (CDC). March 2021. Accessed April 2022.
  10. Fentanyl. Centers for Disease Control and Prevention (CDC). February 2021. Accessed April 2022.
  11. Overdose Death Rates. Centers for Disease Control and Prevention (CDC). January 2022. Accessed April 2022.
  12. Facts About Fentanyl. Drug Enforcement Administration (DEA). Accessed April 2022.
  13. Fentanyl. Drug Enforcement Administration (DEA). Accessed April 2022.
  14. Fentanyl and Fentanyl Analogues Federal Trends and Trafficking Patterns. United States Sentencing Commission. January 2021. Accessed April 2022.

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