Has fentanyl mortality plateaued

An increase in fentanyl-related overdose deaths has driven an overall rise in drug overdose mortality during the COVID-19 pandemic. But is death from fentanyl overdose still rising, or has it reached its peak? The answer appears to be, it depends on where you are. 

In a study of monthly synthetic opioid (principally fentanyl) overdose mortality data between June 2019 and November 2021, drawn from 39 states, the District of Columbia, and New York City, researchers found that in all jurisdictions, fentanyl-related deaths rose dramatically during the study period. But in 29 jurisdictions, they had reached a plateau in the final four months.

In California, for instance, baseline mortality due to synthetic opioid overdose was 29.7 per 100 million population, which rose to 148.4 per 100 million by the end of the study period. The final figure was 498.8% of the baseline figure. The mean of the final 4 months for California compared to the baseline was statistically the same, 492.8%, and thus had plateaued. 

In contrast, in Washington state, the comparable figures were 34.9 per 100 million at baseline and 150 per million at the end, 430.2% of the baseline. The mean for the final four months was lower than this final figure, 403.6%, indicating that the rate was still increasing in the final period of the study.

 “Differing plateau levels in specific parts of the United States may be due to patterns of opioid initiation and use, but also use of other drugs, as illicit synthetic opioids can be mixed in the drug supply for ostensibly non-opioid drugs,” the authors stated. “The lack of observable plateaus at the end of the study period in 10 of the states studied here is also worthy of investigation, given the potential risk of further increases.”

Brown KG, Chen CY, Dong D et al. Has the United States Reached a Plateau in Overdoses Caused by Synthetic Opioids After the Onset of the COVID-19 Pandemic? Examination of Centers for Disease Control and Prevention Data to November 2021. Front Psychiatry. 2022 Jul 7; 13:947603. doi: 10.3389/fpsyt.2022.947603