Steep increases in fentanyl-related mortality west of the Mississippi River: synthesizing recent evidence from county and state surveillance

Abstract

Background and Aims: Overdose deaths from synthetic opioids (e.g., fentanyl), increased 10-fold in the United States from 2013-2018, despite 88% of deaths occurring east of the Mississippi River. Public health professionals have long feared that further spread of fentanyl could greatly exacerbate the opioid epidemic. We aimed to measure and characterize recent fentanyl deaths in jurisdictions west of the Mississippi River. Design: Systematic search of states and counties in the Western U.S. for publicly available data on fentanyl-related deaths since the most recently published Centers for Disease Control and Prevention (CDC) statistics, which cover through December 2018. Longitudinal study using 2019 and 2020 mortality records to identify changes in fentanyl-involved mortality since most recent CDC statistics. Settings: U.S. states west of the Mississippi River. Measurements: Annual rate of fentanyl-involved deaths per 100,000 population. Proportion of fatal heroin-, stimulant, and prescription pill overdoses also involving fentanyl. Findings: We identified nine jurisdictions with publicly available fentanyl death data through December 2019 or later: State of Arizona, Denver County, CO, Harris County, TX, Humboldt County, CA, King County, WA, Los Angeles County, CA, San Francisco County, CA, Siskiyou County, CA, Dallas-Fort Worth, TX metro area (Denton, Johnson, Parker, Tarrant counties. Fentanyl deaths increased in each jurisdiction. Their collective contribution to national synthetic narcotics mortality tripled from 2017 to 2019. First quarter 2020 data (available from all but San Francisco County) showed a 33% growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has grown substantially over time. Conclusions: Fentanyl has spread westward, which could dramatically worsen the already severe opioid epidemic in the United States. Increasing standard-dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.