Why Fentanyl? Why Now?

• In Event: New Insights About Fentanyl Markets & Harm Reduction

Abstract

Synthetic opioids, of which fentanyl is perhaps the most well-known, are now the leading contributory agents in drug overdose deaths in the United States. In 2017, synthetic opioids other than methadone were involved in 40% of the 70,000 overdose deaths and are now found in over half of fatal overdoses for either heroin or cocaine. Synthesized over half a century ago, fentanyl and several of its chemical variants, have been used as general anesthetics and powerful analgesics. Given that these potent opioids can be synthesized without poppy and are liable to abuse, their introduction into heroin markets was portended shortly after their discovery. However, until 2014, only a handful of isolated and brief incidents of synthetic opioids entering US drug markets have been documented. The sudden introduction—and perhaps dominance—of synthetic opioids in some US drug markets today has caught policymakers, researchers, drug users, and the public by surprise. To better understand this phenomenon and what it means for the future of drug policy, we conduct a literature review of documented fentanyl exposures in the US going back to the late-1970s. This and a review of early work by those who predicted fentanyl’s arrival to US drug markets provides a logical framework that outlines the necessary conditions for its diffusion.

Authors

• Bryce Pardo, RAND Corporation

• Beau Kilmer, RAND Corporation