The decrease comes as states implemented laws to reduce supply and improve tracking of the drug. Despite this, deaths attributed to synthetic opioids other than methadone increased 414% during the same time frame.

“Declines in opioid supplies tracked by the Drug Enforcement Agency (DEA) do not necessarily indicate that deaths from those substances are similarly declining,” said Chris Sloan, associate principal at Avalere. “Simply reducing the legal supply of opioids in a state does not immediately lead to fewer opioid deaths.”

Decreases in fentanyl sales ranged across states from nearly 12% to 46% (Table 1). Maine, Tennessee, and Oregon experienced the greatest rates of decline, each with percent changes over 40%.

Meanwhile, every state except Kansas experienced increases in overdose deaths involving synthetic, non-methadone opioids, like fentanyl and tramadol,¹ over the same time period, ranging from 14% to over 1,000% (Table 1).

“Public data cannot distinguish between opioid overdose deaths from legitimate pharmaceuticals and illegally manufactured products,” said Kelly Brantley, managing director at Avalere. “Much of the evidence shows that recent increases in fentanyl-related deaths are linked to illicit products, which requires very different public policy solutions than simply reducing the legal supply.”

Fentanyl is a synthetic opioid more potent than morphine and is frequently involved in overdose deaths. In early 2015, the DEA issued a nationwide alert about the risks associated with fentanyl. In 2016, the US Centers for Disease Control and Prevention (CDC) released opioid prescribing guidelines and a majority of states have enacted laws limiting opioid prescriptions.

While preliminary data from the CDC indicate that national deaths due to opioids likely decreased from 2017 to 2018, deaths due to synthetic opioids likely increased during the same time frame. This indicates that the downward trend in state-level fentanyl supply does not directly correlate with lower rates of death at the state level.² While the percentage change in fentanyl distribution is decreasing, the deaths due to synthetic opioids is still increasing.

Methodology

Avalere analyzed data on fentanyl from the US Drug Enforcement Agency’s Automation of Reports and Consolidated Orders System (ARCOS), which tracks the distribution of controlled substances from the point of manufacture through drug distribution channels to point of sale at the retail or dispensing level. We examined the weight of fentanyl flowing through the drug distribution system as reported to ARCOS from 2014 to 2017. Avalere also utilized data from the Kaiser Family Foundation analysis of the CDC, National Center for Health Statistics Multiple Cause of Death Files (1999–2017) to observe trends in drug overdose deaths that involved synthetic opioids, such as fentanyl, as defined by ICD-10 codes.

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Table 1: Percent Change by State in Synthetic Opioid Deaths and Fentanyl Distribution by Gram Weight, 2014–2017

NSD – not sufficient data

† percent change could not be calculated

References

1. Deaths from synthetic opioids are primarily attributed to fentanyl. National Institute on Drug Abuse. Fentanyl and Other Synthetic Opioids. Drug Overdose Deaths. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/fentanyl-other-synthetic-opioids-drug-overdose-deaths.
2. Centers for Disease Control. Provision Drug Overdose Death Counts. July 7, 2019. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm#COD_classification_definition_drug_deaths.