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Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain.1 It is 50 to 100 times more potent than morphine. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the United States.

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However, most recent cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally made fentanyl.2 It is sold through illegal drug markets for its heroin-like effect. It is often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge—to increase its euphoric effects.

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Overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased by 72% from 2014 to 2015.3 Roughly 9,500 people died from overdoses involving synthetic opioids other than methadone in 2015.3

Reports from law enforcement indicate that much of the synthetic opioid overdose increase may be due to illegally or illicitly made fentanyl. According to data from the National Forensic Laboratory Information System, confiscations, or seizures, of fentanyl increased by nearly 7x from 2012 to 2014. There were 4,585 fentanyl confiscations in 2014.4 This suggests that the sharp rise in fentanyl-related deaths may be due to increased availability of illegally made, non-pharmaceutical fentanyl, and not prescribed fentanyl.

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The number of states reporting 20 or more fentanyl confiscations every six months is increasing. From July to December 2014, 18 states reported 20 or more fentanyl drug confiscations (See Figure 1). By comparison, six states reported 20 or more fentanyl drug confiscations from July to December 2013.