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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

FTC releases findings on how Big Tech eats little tech

Photo illustration: Sarah Grillo/Axios. Photo: An Rong Xu/Washington Post via Getty Images

Federal Trade Commission chair Lina Khan signaled changes are on the way in how the agency scrutinizes acquisitions after revealing the results of a study of a decade's worth of Big Tech company deals that weren't reported to the agency.

Why it matters: Tech's business ecosystem is built on giant companies buying up small startups, but the message from the antitrust agency this week could chill mergers and acquisitions in the sector.

First look: Biden's economic case for green cards

Photo: Win McNamee/Getty Images

The White House Council of Economic Advisors (CEA) is promoting the economic benefits and costs of providing green cards to millions of unauthorized immigrants in a blogpost being released on Friday, according to a draft provided to Axios.

Why it matters: The post comes as the fate of millions of immigrants, including those with Temporary Protected Status or DACA protections, rests with Congress — and the Senate parliamentarian.

Ina Fried, author of Login
35 mins ago - Technology
Column / Signal Boost

Facebook's social balance is in the red

Illustration: Megan Robinson/Axios

Facebook is essential to our lives. Facebook is ruining our lives. Holding both these truths at once will make your head hurt.

While covering the Olympics in Tokyo, I spent a ton of time on Facebook. Each day, during several hourlong bus rides, I would see who was online in Messenger and share photos and stories there with family and friends. I also posted frequently on my news feed.