The crisis of fentanyl and other opioids is far from over in the U.S., and a new study stresses that point, finding that the illicit use of these substances is much more prevalent than prior studies suggest. Published today in JAMA Health Forum, the research reveals that 7.5 percent of adults in the U.S. had used illicitly manufactured fentanyl at some point between June 2023 and June 2024 — a percentage that is more than 20 times higher than past reported rates.

According to the study authors, the results suggests that new methods must be adopted to study the severity of the ongoing opioid crisis.

Read More: The Opioid Crisis Is Not Over

Use of Fentanyl and Other Opioids

Though illicit fentanyl is increasingly tied to fatal overdoses in the U.S., the prevalence of its use is understudied. In fact, the National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA) is one of the largest studies to follow illicitly manufactured fentanyl in the U.S. from year to year, and yet, it has only tracked the substance since 2022. In that year, it found that 0.3 percent of U.S. adults — including individuals aged 18 and above — had used illicitly manufactured fentanyl.

Over the years, some studies have suggested that the use of other illicit opioids, such as heroin, may be much more prevalent than the NSDUH surveys report, leading to questions about the accuracy of their findings on illicit fentanyl. Hoping to figure out the true extent of the issue, the study authors set out to measure the use of illicitly manufactured fentanyl and other illicit opioids more accurately.

Of the 1,500 U.S. adults who were surveyed, around 7.5 percent reported illicit fentanyl use between June 2023 and June 2024, while around 11 percent reported illicit opioid use. The rates of illicitly manufactured fentanyl were more than 20 times higher than the NSDUH rates from 2022 — a difference that is consistent with those reported in previous research, assuming that year-to-year opioid use is increasing.

The findings suggest that illicit fentanyl use may be underestimated by the NSDUH, stressing the need to avoid such overestimations in the future.

“Estimates of illicit opioid use are rare and typically are available only years after the information is collected, limiting our ability to monitor trends on a near-term basis,” said David Powell, a study author and an economist at RAND, a nonprofit research organization, according to a press release. “Our study offers a method to quickly and repeatedly monitor illicit opioid prevalence at low-cost.”

Read More: This Is What Makes Certain Opioids More Deadly Than Others

Intentional and Unintentional Use

Conducted online and including a sweeping sample of U.S. adults, the new study asked participants about their use of illicit fentanyl and other illicit opioids, including their intentional and unintentional use. Around 4.9 percent of the participants reported that they had used illicit fentanyl intentionally, while around 2.6 percent reported that they had used it unintentionally.

Interestingly, around 25 percent of the participants who used illicit opioids reported that illicitly manufactured substances were involved in their first opioid use, whereas around 39 percent and 36 percent reported that prescribed or unprescribed prescription opioids were involved, instead.

According to the study authors, additional research is required to better understand the differences between their results and the NSDUH results, but it is possible that the differences between the two relate to the set-ups of the two studies, with one occurring completely online, and the other occurring only partly online. Since a portion of the NSDUH responses are collected in person, it is possible that some of its respondents shied away from accurately reporting their use of illicitly manufactured fentanyl. (That said, the study authors stress that online surveys can introduce their own issues into data.)

“Ultimately, the data presented here should be treated as a substantive data point for understanding and curtailing the ongoing opioid crisis,” said Mireille Jacobson, another study author and an economist at the University of Southern California, according to a press release. “More near real-time information is needed to evaluate not only where we are in the epidemic, but, more importantly, whether we are making progress in reining it in.”

This article is not offering medical advice and should be used for informational purposes only.

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Article Sources

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Sam Walters is a journalist covering archaeology, paleontology, ecology, and evolution for Discover, along with an assortment of other topics. Before joining the Discover team as an assistant editor in 2022, Sam studied journalism at Northwestern University in Evanston, Illinois.