"Deaths involving synthetic opioids in the United States increased from roughly 3,000 in 2013 to more than 30,000 in 2018. In fact, synthetic opioids like fentanyl are now involved in twice as many deaths as heroin. This book offers a systematic assessment of the past, present, and possible futures of synthetic opioids in the United States. It is rooted in secondary data analysis, literature reviews, international case studies, and key informant interviews. The goal is to provide decisionmakers, researchers, media outlets, and the public with insights intended to improve their understanding of the synthetic opioid problem and how to respond to it.
The authors conclude that (1) fentanyl and other synthetic opioids are
becoming dominant in some parts of the United States and Canada, but
remain less common in other parts of these countries; (2) a confluence
of factors, including the dissemination of simplified and novel
synthesis methods and increasing e-commerce, helps explain the surge in
synthetic opioids; (3) much can be learned from other countries'
experiences with synthetic opioids; (4) supplier decisions, not user
demand, drive the transition to fentanyl; (5) fentanyl's spread is
episodically fast and has ratchet-like persistence; (6) synthetic
opioids drive up deaths rather than the number of users; (7) problems
with synthetic opioids are likely to worsen before they improve, and
states west of the Mississippi River must remain vigilant; (8) improving
surveillance and monitoring is crucial; and (9) limiting policy
responses to existing approaches seems unlikely to reverse this tide."
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