In 2021, 70,601 people died from a fentanyl overdose in the US. That figure is up 25% from 2020 and is nearly double the amount of fentanyl overdose deaths in 2019.

Initially, opioid deaths were largely driven by a flood of legal prescriptions for drugs such as Hydrocodone, Oxycodone, Oxymorphone, and Morphine. But in recent years, as prescriptions fell, illicit fentanyl became the main cause of overdose deaths.

The fentanyl epidemic has reached every state, but the effects are not felt equally across the US. When adjusted for population, West Virginia and Washington, DC had the highest rates of opioid overdose deaths.

Line chart of fentanyl overdose deaths in the US where the amount of deaths rises steeply in the past decade

What is fentanyl and why is it so dangerous?

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Like other opioids, fentanyl use can lead to dependency and addiction.

Pharmaceutical fentanyl was approved by the Food and Drug Administration as a pain reliever in 1998 and is typically prescribed to patients with severe or chronic pain. Although pharmaceutical fentanyl can be abused and or sold illegally, the most recent cases of overdoses and deaths are from illegally made fentanyl.

Drug dealers may mix fentanyl with illicit drugs such as heroin, cocaine, methamphetamine, and MDMA to increase the drugs’ effects — sometimes without the user’s knowledge. Because fentanyl is significantly stronger than other opioids, doses as small as two milligrams can be lethal. And with users unaware of how much fentanyl they are using, it’s an especially dangerous combination. The Drug Enforcement Administration recently found that 6 out of 10 fentanyl-laced fake prescription pills contain a potentially lethal dose of fentanyl.

The CDC tracks drug overdose deaths with the International Classification of Diseases, 10th Revision (ICD-10), which records fentanyl overdose deaths alongside those caused by other synthetic opioids. However, fentanyl accounts for most synthetic opioid deaths. Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one ICD-10 category when describing the number of drug overdose deaths involving specific drugs.

When did fentanyl deaths begin to rise?

Fentanyl overdose deaths in 2021 were over 26 times higher than a decade prior. Since 2012, fentanyl overdose deaths have increased every year. Fentanyl is responsible for more than half of all yearly opioid overdose deaths since 2017.

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In recent years, deaths from fentanyl overdose rose sharply, overtaking deaths from prescription opioids and heroin. This change is likely attributed to a decline in opioid prescription rates and reformulations to drugs such as Oxycontin aimed at curbing abuse, along with the growing rate at which illegally made fentanyl is combined with other illicit drugs.

From 2010 to 2020, the rate of opioid prescriptions dispensed per 100 people dropped from 81.3 to 43.3, a decline of nearly 47%. In West Virginia — the state with the highest rate of opioid prescriptions in 2010 — prescription rates fell by 62%. Despite the waning availability of prescription opioids, total overdose deaths involving any opioid more than tripled during the same period.

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Where are people dying from fentanyl overdoses?

Comparing the rate of fentanyl overdose deaths per 100,000 residents can help show how widespread the epidemic has become.

When adjusted for population, West Virginia had the highest rate of fentanyl overdose deaths in the country in 2021. The state had 66 deaths per 100,000 people due to fentanyl overdoses, which is about 44% higher than Washington, DC. Of the 10 states or territories with the highest rates, only Ohio ranked in the top 10 in total population.

South Dakota had the lowest rate of fentanyl overdose deaths among states in 2021, with 3.7 deaths per 100,000 residents. Of the 10 states with the lowest rates, only Texas ranked in the top 10 in total population.

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How to seek treatment for an opioid addiction

If you or someone you know is experiencing substance use disorders, the Department of Health & Human Services offers a free, confidential, 24/7, 365-day-a-year treatment referral and information service for individuals and families facing mental and/or substance use disorders.

Read more about opioid use in the US with Opioid addiction deaths, and treatment: The latest analysis of the data, or explore more data on drug overdose deaths.

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Fentanyl Deaths in the US: Data Explained

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