Synthetic Opioids Involved In More Overdose Deaths Than Prescription Opioids

By Kelly Burch 05/07/18

Researchers also discovered that 80% of overdose deaths involving synthetic opioids also featured other drugs.

doctor holding defibrillator

Synthetic opioids such as fentanyl and carfentanil are now present in more opioid overdose deaths than prescription opioids, changing the face of the opioid epidemic that was initially spurred by prescription drugs. 

According to a study published in the Journal of the American Medical Association (JAMA), synthetic opioids were present in 46% of opioid overdose deaths in 2016, while prescription opioids were present in 40%, and heroin was involved in 37%. 

"It's certainly concerning. I think that it tracks very closely with the increased availability of illicit synthetic opioids that are coming into the U.S.," Christopher Jones, director of the National Mental Health and Substance Use Policy Laboratory at the Substance Abuse and Mental Health Services Administration (SAMHSA) and lead author of the study, told CNN

Jones noted that since many death certificates do not specify a drug type, the actual number of overdoses is likely significantly higher than the 42,249 that researchers examined. 

"Somewhere between 15 and 25% of the overdose deaths don't list specific drugs," he said. 

Researchers also discovered that 80% of overdose deaths featuring synthetic opioids also involved other drugs: half involved other opioids; 22% involved cocaine, 17% involved benzodiazepines; 11% involved alcohol, and 5% involved antidepressants.

"Initially when synthetic opioids showed up in the U.S., it was largely mixed with heroin. But now we're seeing it mixed with cocaine, methamphetamines and other substances of abuse. And in the last couple of years we've seen this proliferation of counterfeit tablets that are made to look like commonly abused prescription drugs," Jones said. "And that's particularly concerning because people who are not regularly exposed to opioids are going to be at an increased risk of the respiratory depressant effects of opioids because they have no tolerance."

Although overdoses from fentanyl have increased rapidly since 2010, when they were only involved in 14% of opioid deaths, the number of legal fentanyl prescriptions has remained stable. That indicates that most overdoses involve fentanyl that is made illegally, often in China, according to U.S. officials. 

"Synthetic opioids are significantly easier to manufacture. They're manufactured in a lab, as opposed to fields of poppies that have to be cared for and cultivated and farmed," said Lindsay LaSalle, senior staff attorney for the nonprofit Drug Policy Alliance.

The fentanyl is made in China then shipped, "broadly speaking," to Mexico, where it is mixed with heroin before entering the drug supply in America, she said. Because fentanyl overdoses occur quickly, they are particularly dangerous. 

"Fentanyl overdoses occur over a matter of minutes, as opposed to heroin overdoses that occur over a matter of hours. So the response time for a heroin overdose is much longer, and there's enough time to call 911 to get EMS out there," LaSalle said.

With fentanyl overdoses, "many times, the needle is still inserted in people's arms. That is how quickly it happens."

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.