U.S. adults' use of illicit opioids 20 times higher than previously estimated, survey says
Researchers said government counts may significantly underestimate illicit drug use, and they suggest new methods are needed to better track the nation's opioid crisis, which transitioned from heroin in the early 2010s to illicitly manufactured fentanyl a few years later.
In a study published by Journal of American Medical Association Health Forum, researchers found 11% of 1,515 American adults reported illicit opioid use within the past 12 months and 7.5% use of illicitly produced fentanyl. They were surveyed online from June 10-17, 2024.
Among those surveyed, 7.7% reported intentional nonprescription opioid use and 3.2% unintentional nonprescription opioid use.
The rate of intentional use of illicitly manufactured fentanyl was 4.9% and unintentional use of fentanyl 2.6%.
The National Survey on Drug Use and Health reported only 0.3% of adults in 2022 used illicitly manufactured fentanyl in the largest ongoing study that tracks illicit drug use. They found 991,000 people age 12 or older misused prescription fentanyl or used illegally made fentanyl in the past year, including 686,000 people who used IMF in the past year.
"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," David Powell, the study's lead author and a senior economist at RAND, or Research ANd Development, a nonprofit research organization. "Our study offers a method to quickly and repeatedly monitor illicit opioid prevalence at low cost."
Most overdose deaths are traced to illegally manufactured fentanyl. In 2023, an estimated 74,702 people in the United States died from overdoses involving synthetic opioids, primarily fentanyl, according to the Centers for Disease Control and Prevention. In 2012, the number of death reported was 2,628 and spiked to 19,413 four years later.
Fentanyl is deadly because it is 50 times stronger than heroin and 100 times stronger than morphine as just 2 milligrams can be lethal, according to the U.S. Drug Enforcement Agency. Drug dealers may mix fentanyl with other drugs, including heroin, cocaine, meth and MDMA to increase the drugs' effects. Often that user is not aware of this.
DEA seized 60 million fentanyl-laced fake pills and nearly 8,000 pounds of fentanyl powder in 2024. These are the equivalent to more than 380 million lethal doses of fentanyl.
In April, DEA and nearly 4,500 law enforcement agencies dispose of more than 620,000 pounds of unneeded and expired medications.
Other studies have reported higher rates of illicit opioid use, but half have been done in person, which may inhibit participants from reporting illicit drug use.
"This study underscores the importance of improved data collection methods to effectively address the opioid crisis because national estimates of rates of illicit opioid use are typically released with a considerable lag time and may be underreported," researchers said.
In the new study, 39% reported their first use of opioids involved medication prescribed to them and 36% their first use involved prescription opioids not prescribed to them. The remaining 25% said their first exposure to opioids involved illicitly manufactured opioids.
"Ultimately, the data presented here should be treated as a substantive data point for understanding and curtailing the ongoing opioid crisis," Mireille Jacobson, the study's co-author and an economist at USC, said. "More near real-time information is needed to evaluate not only where we are in the epidemic, but, more importantly, whether we are making progress in reining it in."
Researchers said one limitation of the survey could be the use of an online platform. Though the demographics were similar to other studies, the surveyed population could be different in unobserved ways, they said. The authors said they want to re-examine their findings soon, using a survey platform addressing those concerns.
Arnold Ventures and the National Institutes of Health's National Institute on Drug Abuse provided support for the study.
Settlements have been reached in selling prescription opioids.
In January, the Sackler family agreed to pay $6.5 billion over 15 years and Purdue Pharma $900 million for a total of $7.4 billion to end federal court claims filed by attorneys general on behalf of 15 states. The settlement ended the Sacklers' control of Purdue Pharma and their ability to sell opioids in the United States.
In April, Walgreens agreed to pay as much as $350 million in a settlement over illegally filled prescriptions for addictive opioid drugs and false reimbursement claims to the federal government.
Last December, the Justice Department sued CVS Pharmacy and various subsidiaries in violation of the Controlled Substances Act and sought reimbursement from federal healthcare programs for unlawful prescriptions in violation of the False Claims Act. CVS is the country's largest pharmacy chain ahead of Walgreens.
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