Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports

Summary

What is already known about this topic?

Opioid overdose deaths in the United States have been increasing since 1999, initially driven by prescription opioid misuse and more recently by heroin and other illicit opioid use.

What is added by this report?

Rates of deaths involving heroin increased in all U.S. Census regions from 2006 to 2015. The increase appears to be driven in part by increases in the heroin supply after 2010 and by the introduction of illicitly manufactured fentanyl (IMF), a synthetic opioid, into the heroin market. Deaths involving both heroin and synthetic opioids increased sharply after 2013. The largest increases were in regions where white powder heroin is primarily used. Deaths involving synthetic opioids without heroin also increased sharply after 2013, indicating emergence of synthetic products without heroin or mixing of IMF into other drugs, including cocaine.

What are the implications for public health practice?

Changes in the supply and potency of illicit drug products can substantially contribute to increases in overdose deaths regardless of rates of opioid misuse. With continued increases in the heroin and synthetic opioid supply and deaths in the context of prescription opioid misuse, sustained, targeted, and multisectoral responses to the opioid overdose epidemic are needed, including timely surveillance, safer opioid prescribing, education on opioid overdose and naloxone, linkage and access to treatment, leveraging of community-based services, and collaboration between public health and public safety agencies.