Study reveals unequal burden of the fentanyl epidemic across the United States

A new study illuminates how some areas of the country have been hit much harder than others by the fentanyl epidemic, which took more than 70,800 lives in 2022 alone.

The research calls attention to a need for focused, coordinated efforts to prevent overdose deaths in the places where deaths from the opioid are rampant, said lead author Thomas Wickizer, a professor emeritus in The Ohio State University College of Public Health.

The study appears in the journal Health Affairs Scholar.

We can look at this map and see there are certain areas which are experiencing this at an extremely dire rate, and energy and resources, including financial investments, should be shifted toward the areas with the greatest potential impact."

Thomas Wickizer, professor emeritus in The Ohio State University College of Public Health

"There's no fentanyl epidemic in South Dakota or Wyoming or Nebraska. But in Kentucky, West Virginia, New England, Ohio … there's this intense concentration and it's taking a huge toll."

The research team studied data from 2022, when more than 70,800 people died of unintentional overdoses, a 31-fold increase over the 2,139 U.S. fentanyl deaths a decade before. The numbers have skyrocketed as fentanyl - which is 50 to 100 times more potent than morphine - has become more widely available.

Because it is relatively cheap to illegally manufacture, smuggle and distribute, and because it can be made to mimic the looks of prescription medications, fentanyl has become a powerful and deadly actor in the international drug trade.

"This is the worst manmade epidemic in U.S. history," Wickizer said.

In 2022, West Virginia's toll, at 75 per 100,000 deaths, was 15 times greater than that of South Dakota. Other areas with high fentanyl mortality rates included Washington, D.C., (58), Kentucky (45) and Ohio (42).

The study also attaches an economic loss to those deaths - adding another layer of understanding to the harm fentanyl deaths cause not just to individuals and families, but to society.

The research team estimated the nationwide toll in 2022 was at least 2 million years of life lost, corresponding to an economic loss on the order of $57 billion to $67 billion. They estimated that Ohio incurred the largest economic loss, with $3 billion in losses based on more than 3,900 deaths in 2022.

"These economic loss measures are another way to illustrate the brutality of the drug on people's lives, on their communities. There is such a tremendous amount of pain and loss," Wickizer said.

Local, state or regional efforts to combat the fentanyl epidemic may be more valuable than national approaches, the study authors said.

"It's also important to recognize this cuts across different sectors. If you're going to be successful, you need to engage public health, health care, law enforcement, social services, schools and others," Wickizer said.

A model in Cuyahoga County, Ohio - home to Cleveland - may serve as inspiration for others looking to save lives due to fentanyl overdoses, said Rachel Mason, study co-author and an Ohio State PhD student in health services management and policy.

The Cuyahoga County program, funded by the Alcohol, Drug Addiction and Mental Health Services Board, was among 72 Mason and Wickizer surveyed in 2023.

There, fentanyl test strips were once considered drug paraphernalia. Now, they're made available through a county-level program with multiple partners, she said. Along with harm reduction efforts including strips that allow drug users to test for fentanyl, the county's successful program included social marketing to make people aware that drugs - anything from Adderall to heroin - could contain the opioid.

Other researchers who worked on the study are Evan Goldstein and Nasser Sharareh of the University of Utah's School of Medicine.