How Fentanyl Addiction Surged in America

Fentanyl overdose, paramedics at work
Photo by Tashi-Delek/

Almost every year since 1999, more people died from drug overdoses than the year prior. The crisis has developed and become so serious that drug overdoses are now one of the leading causes of preventable death in America.

It’s not logical to look for just one factor that caused a National Public Health Emergency like the addiction epidemic. However, it is possible to examine one of the causes of the crisis, fentanyl. Since it was introduced, fentanyl has caused more drug overdose fatalities than any other drug. Understanding this substance and how it became a lethal agent in the American addiction crisis will be crucial to unraveling the epidemic and helping Americans recover from it.

Fentanyl Defined

The Centers for Disease Control and Prevention define fentanyl as such: “Pharmaceutical fentanyl is a synthetic opioid, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the United States.”

The National Institute on Drug Abuse (NIDA) has a similar definition for fentanyl. According to their research findings, fentanyl is a powerful synthetic opioid, 50 to 100 times more potent than morphine and ten times more potent than heroin. When the FDA first approved it, fentanyl was intended only for cancer patients and persons with chronic pain who had developed tolerances to other pain reliever drugs. Sometimes, doctors used it to treat patients who were recovering from surgery.

Fentanyl is a synthetic opioid, meaning scientists make it in a lab. It is made using the same chemical structure of the opium poppy plant but with chemical ingredients rather than naturally occurring materials.

The Difference Between Pharmaceutical Fentanyl and Illicit Fentanyl

According to NIDA, fentanyl and other synthetic opioids are the leading cause of overdose deaths in the United States. This trend has developed and worsened considerably over the years. For example, in 2017, fentanyl was involved in 59% of opioid-related deaths, compared to just 14% of such deaths in 2010.

In more recent years, much of the surge in fentanyl-related deaths have resulted from illicit fentanyl.

What's the difference between pharmaceutical fentanyl and illicit fentanyl?

When prescribed by a doctor, fentanyl can be given as a shot, a patch, or a lozenge. This is pharmaceutical fentanyl, as it is made by a pharmaceutical company and is intended for medical use. It can still be misused, certainly, and it is still addictive. But it is made with the intention of medical, ethical use.

Illicit lab
Photo by SrdjanPav/

Illicit fentanyl is lab-made fentanyl concocted in clandestine drug labs, intended for “recreational” use. This type of fentanyl is usually sold as a powder, dropped onto blotter paper, put in eyedroppers and nasal sprays, or made into pills that look like prescription opioids (more on counterfeit opioids later).

One of the major risks in illicit fentanyl is that drug dealers often mix fentanyl with other drugs, such as heroin, cocaine, methamphetamine, and MDMA. They do this because it takes very little fentanyl to produce an immense high, making it cheaper for drug dealers to produce a product that addicts want to buy.

And the risks are serious, as addicts expecting to buy heroin, cocaine, meth, or MDMA are not anticipating fentanyl. They will often unknowingly take too much of the drug, experience an overdose, and die.

Fentanyl Overdose Statistics

Fentanyl is responsible for a huge percentage of annual overdose deaths. For example, according to the National Institute on Drug Abuse, deaths involving synthetic opioids (primarily fentanyl) reached 36,359 in 2019. That number represents more than half of the total 70,630 overdose deaths that year.

Not only does fentanyl account for the majority of total drug deaths, but it also accounts for the vast majority of opioid-related deaths. For example, in 2019, 17,029 people died from prescription opioids, and 14,019 died from heroin. Fentanyl and other synthetic opioids killed more people in 2019 than prescription painkillers and heroin combined.

When considering fentanyl deaths, it's important to understand that most of these deaths are caused by illicit fentanyl, not legally, ethically prescribed fentanyl. According to the CDC, overdose deaths involving synthetic opioids (mainly illicit fentanyl) were 12x higher in 2019 than in 2013.

Buying street drugs
Photo by South_agency/

Another reason for the upsurge in fentanyl-related deaths is that fentanyl has been added to different drugs, usually without addicts being made aware of that fact. As mentioned earlier, drug dealers will often add fentanyl to other drugs to make them more potent (and addictive). The result? Recent years have seen a surge in deaths related to heroin, meth, cocaine, or MDMA laced with fentanyl. Most of these deaths occur because the addicts taking the drugs do not know that fentanyl has been laced into the drug, so they consume too much of the drug, and they die.

Fentanyl Being Sold as Fake OxyContin (Counterfeit Opioids)

There is another recent trend that has contributed to fentanyl-related deaths. Some drug dealers are now producing what are called “counterfeit painkillers.” These are pills that are labeled as OxyContin or a different type of popular painkiller, but they are really fentanyl.

A story out of Minneapolis highlighted by the Drug Enforcement Administration discussed just how dangerous it is when drug dealers produce illicit fentanyl and then label it as a pharmaceutical painkiller. Quoting Omaha Division Special Agent in Charge Richard Salter Jr., “There is no quality control in these counterfeit pills. Drug trafficking organizations do not employ scientists or use professional laboratories to create these deadly pills, and therefore they cannot create the safe chemical mixtures that their legitimate pharmaceutical counterparts do. A lethal dosage of fentanyl is two milligrams, equivalent in size to a few grains of salt, as compared to a lethal dose of heroin at 30 milligrams. Each time someone takes a counterfeit pain pill, they are playing Russian roulette with their life. If a doctor didn’t prescribe it, or if the pill isn’t coming from a pharmacy, it’s very likely counterfeit.”

Fentanyl – A Recent Crisis and the Three Waves of Opioid Overdose Deaths

In another report, the CDC laid out the three waves of the opioid epidemic, revealing how fentanyl became such a key component in this crisis. According to the CDC, the opioid epidemic occurred in the following waves:

  • The first wave began in the late-1990s with prescription opioid pain relievers. Pharmaceutical manufacturers convinced doctors to increase the prescribing of opioids like OxyContin, lying to doctors by saying that the pills were not addictive. That led to the first wave of addiction and overdoses.
  • The second wave began in 2010 with a sudden and rapid increase in overdose deaths involving heroin.
  • The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly illicitly-manufactured fentanyl. At the time of this writing, we are still in the third wave of the opioid crisis, with there being no sign that deaths will go down any time soon.

Overcoming Fentanyl Addiction – The Need for Treatment

Fentanyl addiction is severe and life-threatening. If you know someone who is addicted to fentanyl, make sure they get help as soon as possible.


Reviewed by Matt Hawk, BS, CADC-II, ICADC



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.