When comparing overdose death rates by sex, men had higher death rates than women for all five drugs analyzed in the report. 

Across all age groups, fentanyl had the highest overdose deaths rates. The groups with the highest fentanyl death rates were individuals ages 35 to 44 (43.5 deaths per 100,000 people) and those ages 25 to 24 (40.8 deaths per 100,000 people). 

After adjusting for age, the researchers found that American Indian or Alaska Native individuals had the highest rates of fentanyl deaths at 33.1 per 100,000 people — roughly 1.3 times higher than the death rate among white individuals. This group also had significantly higher death rates for methamphetamine.

Black Americans also had disproportionately high fentanyl death rates (31.3 per 100,000 people) and cocaine death rates (20.6 per 100,000 people).

The researchers also found geographic differences in fentanyl overdose death rates. HHS Region 1 (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and Region 3 (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia) had the highest fentanyl death rates in the country at 32.2 and 32 per 100,000 people, respectively.

Commentary

According to the  Drug Enforcement Administration, there has been a shift from a heroin-based drug market to a fentanyl-based market, which has likely played a role in the significant jump in overdose deaths from the drug. In 2021 alone, fentanyl contributed to around 80,000 opioid overdose deaths in the United States.

"The vast majority of our folks or patients with substance use disorders, even if they don't know it, they're primarily using the drug supply that's primarily fentanyl," said Allison Lin, an addiction psychiatrist at the  University of Michigan Medical School. "So, the folks who were using heroin previously are the folks who are also using fentanyl now. It's just that the supply of opioids and other drugs in our communities are primarily supplies that are predominantly fentanyl because of all the characteristics of it, how inexpensive it is, how easy it is to cut with other substances, other factors."

"We are always hoping we won't see a rise in fentanyl deaths, but this really highlights that this is continuing to be the public health problem," said Merianne Spencer, a CDC researcher and one of the report's authors.

To combat the growing fentanyl epidemic, the United States and Mexico have recently partnered to tackle the fentanyl supply chain. The White House has also declared combinations of opioids, including fentanyl and xylazine, an animal tranquilizer, as an "emerging drug threat."

Next week, FDA  and the  Substance Abuse and Mental Health Services Administration will hold a public two-day meeting about the best way to initiate addiction treatment for those using opioids. Several states are also meeting separately to discuss the impact of fentanyl distribution and possession penalties and whether they could reduce overdose deaths. (McPhillips, CNN, 5/3; Kekatos, ABC News, 5/2; Moreno, Axios, 5/3; Firth, MedPage Today, 5/3; Sforza, The Hill, 5/3; Peng, Bloomberg, 5/2; Spencer et al., Vital Statistics Rapid Release, accessed 5/4) 

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