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Steep increases in fentanyl-related mortality west of the Mississippi River: recent evidence from county and state surveillance.
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Abstract
Background Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River. Public health professionals have feared a “fentanyl breakthrough” in western U.S. drug markets could further accelerate overdose mortality. We evaluated the number and nature of western U.S. fentanyl deaths using the most recent data available. Methods We systematically searched jurisdictions west of the Mississippi River for publicly available data on fentanyl-related deaths since 2018, the most recent Centers for Disease Control and Prevention (CDC) statistics. Using mortality data from 2019 and 2020, we identified changes in fentanyl-related mortality rate and proportion of fatal heroin-, stimulant, and prescription pill overdoses involving fentanyl. Results Seven jurisdictions had publicly available fentanyl death data through December 2019 or later: Arizona; California; Denver County, CO; Harris County, TX; King County, WA; Los Angeles County, CA; and Dallas-Fort Worth, TX (Denton, Johnson, Parker, and Tarrant counties). All reported increased fentanyl deaths over the study period. Their collective contribution to national synthetic narcotics mortality increased 371 % from 2017 to 2019. Available 2020 data shows a 63 % growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has substantially grown. Discussion Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation’s already severe opioid epidemic in the long-term. Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.
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“However, fentanyl did not saturate each state’s unregulated drug market at the same time25; from about 2013 onward, it spread from east to west over the course of several years.20,26”
From Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon (2024) · cites this paper as [26]
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Metadata
- Authors
- Shover, C. L., Falasinnu, T. O., Dwyer, C. L., Santos, N. B., Cunningham, N. J., Freedman, R. B., Vest, N. A., & Humphreys, K.
- Affiliations
- Stanford Medicine (US)
- VA Palo Alto Health Care System (US)
- University of California, Los Angeles (US)
- Los Angeles LGBT Center (US)
- Brown University (US)
- Corresponding author
- Shover, Chelsea L.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 216
- Pages
- 108314
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC7521591
- OpenAlex
- W3090555497
- Semantic Scholar
- 14ab5e310f56292fe3ca12fc9baea747bfd402e5
- Cited by
- 162
- References
- 32
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 24 · 2023: 31 · 2022: 36 · 2021: 32 · 2020: 3
- FWCI
- 19.09
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Wu Tsai Neurosciences Institute, Stanford University
- National Institute on Drug Abuse
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- fentanyl, opioid overdose deaths, synthetic opioids, opioid epidemic, American West, heroin overdose, stimulant overdose, naloxone, access to addiction treatment, Medicaid expansion, public health education
- MeSH terms
- Analgesics, Opioid, Heroin, Female, Fentanyl, Humans, Longitudinal Studies, Male, Local Government, Opioid-Related Disorders, Population Surveillance, State Government, Illicit Drugs, United States, Drug Overdose
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