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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

Trump's legacy is shaped by his narrow interests

Illustration: Annelise Capossela/Axios

President Trump's policy legacy is as much defined by what he's ignored as by what he's involved himself in.

The big picture: Over the past four years, Trump has interested himself in only a slim slice of the government he leads. Outside of trade, immigration, a personal war against the "Deep State" and the hot foreign policy issue of the moment, Trump has left many of his Cabinet secretaries to work without interruption, let alone direction.

Updated 3 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: The good and bad news about antibody therapies — Fauci: Hotspots have materialized across "the entire country."
  2. World: Belgium imposes lockdown, citing "health emergency" due to influx of cases.
  3. Economy: Conference Board predicts economy won’t fully recover until late 2021.
  4. Education: Surge threatens to shut classrooms down again.
  5. Technology: The pandemic isn't slowing tech.
  6. Travel: CDC replaces COVID-19 cruise ban with less restrictive "conditional sailing order."
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AI and automation are creating a hybrid workforce

Illustration: Annelise Capossela/Axios

AI and automation are receiving a boost during the coronavirus pandemic that in the short term is creating a new hybrid workforce rather than destroying jobs outright.

The big picture: While the forces of automation and AI will eliminate some jobs and create some new ones, the vast majority will remain but be dramatically changed. The challenge for employers will be ensuring workforces are ready for the effects of technology.