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A bag of fentanyl seized by law enforcement. Photo: David L. Ryan/The Boston Globe via Getty Images

Although opioid prescriptions in the U.S. have fallen, opioid overdose deaths — 47,000 in 2018 — remain at historic levels. The continued spread of fentanyl and other illicitly manufactured synthetic opioids suggest the problem could still get worse.

The big picture: Inexpensive and widely available on the internet, fentanyl is attractive to dealers who make counterfeit prescription pills or mix it into heroin. Fentanyl, however, is extremely potent, leading more users to fatally overdose.

What's happening: So far, fentanyl deaths are largely concentrated in parts of Appalachia, the mid-Atlantic and New England, with western states less exposed.

Between the lines: Fentanyl isn’t attracting new drug users. Rather, it’s an ingredient suppliers use to cut costs but most consumers seek to avoid (heroin import prices are at least 100 times higher per dose).

  • The problem is thus more like a poisoning outbreak than a traditional drug epidemic driven by user demand.
  • Meanwhile, the rise of e-commerce has made it easier to order fentanyl online, most often shipped from China.
  • Synthetic opioids are also mentioned in an increasing number of cocaine and methamphetamine deaths (though it is unknown if fentanyl was added by suppliers or taken separately by users). One analysis from Ohio, however, found fentanyl in 12% of retail-level cocaine seizures.

What to watch: With the Oct. 2 federal ruling in favor of Philadelphia’s proposed supervised consumption site, other jurisdictions may give such facilities a more serious look. Expect further discussion about improving fentanyl detection technologies and pilot programs for prescription heroin too.

Go deeper: Read “The Future of Fentanyl and Other Synthetic Opioids” from RAND.

Bryce Pardo is an associate policy researcher at the RAND Corporation. Beau Kilmer is the director of the RAND Drug Policy Research Center.

Go deeper

House passes $1.9 trillion COVID relief package

Photo: Screenshot via C-SPAN

The House approved President Biden's $1.9 trillion COVID relief package on a 219-212 vote early Saturday morning, sending it to the Senate for a possible rewrite before it gets to Biden's desk.

The big picture: The vote was a critical first step for the package, which includes $1,400 cash payments for many Americans, a national vaccination program, ramped-up COVID testing and contact tracing, state and local funding and money to help schools reopen.

10 hours ago - Health

Biden says it's "not the time to relax" after touring vaccination site

President Biden speaking after visiting a FEMA Covid-19 vaccination facility in Houston on Feb. 26. Photo: Mandel Ngan/AFP via Getty Images

President Biden said Friday that "it's not the time to relax" coronavirus mitigation efforts and warned that the number of cases and hospitalizations could rise again as new variants of the virus emerge.

Why it matters: Biden, who made the remarks after touring a vaccination site in Houston, echoed CDC director Rochelle Walensky, who said earlier on Friday that while the U.S. has seen a recent drop in cases and hospitalizations, "these declines follow the highest peak we have experienced in the pandemic."

Updated 11 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Annelise Capossela/Axios

  1. Health: Most COVID-19 survivors can weather risk of reinfection, study says — "Twindemic" averted as flu reports plummet amid coronavirus crisis
  2. Vaccine: FDA advisory panel endorses J&J COVID vaccine for emergency use — About 20% of U.S. adults have received first vaccine dose, White House says — New data reignites the debate over coronavirus vaccine strategy.
  3. Economy: What's really going on with the labor market.
  4. Local: All adult Minnesotans will likely be eligible for COVID-19 vaccine by summer — Another wealthy Florida community receives special access to COVID-19 vaccine.
  5. Sports: Poll weighs impact of athlete vaccination.