Americans are consuming illegal opioids at rates far higher than government estimates suggest, according to a groundbreaking new survey that challenges our understanding of the opioid crisis.
At a Glance
- A new survey indicates 11% of Americans reported illicit opioid use in the past year, with 7.5% reporting use of illicitly manufactured fentanyl – 25 times higher than official government data
- Drug overdoses were a leading cause of injury death in the U.S. in 2015, resulting in approximately 52,000 deaths
- Nonmetropolitan areas have seen a 325% increase in drug overdose death rates from 1999 to 2015
- 70% of illicit opioid use was intentional, with 39% of users first exposed through prescribed opioids
- CDC estimated 65,000 deaths from synthetic opioids, including fentanyl, in the year ending June 2024
Government Data Significantly Underestimates Opioid Crisis
Federal data has long been the backbone of America’s response to the opioid epidemic, but new research suggests we’ve been fighting this battle with incomplete information. A groundbreaking survey shows that illegal opioid use in America is dramatically more widespread than official government estimates indicate. The survey found that 11% of respondents reported using illicit opioids in the past year, with an alarming 7.5% admitting to using illicitly manufactured fentanyl (IMF) – a figure 25 times higher than what government data shows.
“A number of previous studies also have reported higher rates of illicit opioid use, challenging the accuracy of the federal estimate”, reported the RAND press release.
Critics point to significant flaws in the National Survey on Drug Use and Health (NSDUH), which many policymakers rely on for data. The NSDUH methodology excludes high-risk populations such as incarcerated and homeless individuals. Additionally, the survey’s in-person format may discourage honest reporting about illegal drug use.
By contrast, the new online survey conducted by Respondi likely encouraged greater candor from participants, resulting in data that paints a more accurate picture of America’s opioid crisis.
Rural America Hit Hardest by Rising Overdose Deaths
While metropolitan areas initially experienced higher rates of drug overdose deaths, by 2015 the tide had turned, with nonmetropolitan areas slightly surpassing their urban counterparts. This shift represents a dramatic 325% increase in drug overdose death rates in rural communities from 1999 to 2015. Though urban areas still account for more total deaths due to larger populations, the rapid acceleration in rural America demands immediate attention from policymakers and healthcare providers.
According to a CDC statement: “Drug overdoses are now the leading cause of injury death in the United States, and although prescription drugs were primarily responsible for the rapid expansion of this large and growing public health crisis, illicit drugs (heroin, illicit fentanyl, cocaine, and methamphetamines) now are contributing substantially to the problem.”
The demographic landscape of drug use has also shifted significantly over time. While drug use among youth aged 12-17 has declined, it has increased markedly among adults aged 26-34 and those 35 and older. These changing patterns emphasize the need for age-appropriate intervention strategies and recognition that the opioid crisis is not limited to any single demographic group but affects Americans across all walks of life.
Understanding Pathways to Addiction
The new survey provides critical insights into how Americans first encounter opioids. Of those reporting illicit use, 70% indicated their use was intentional rather than accidental. Perhaps most telling for healthcare policy, 39% of illicit users were first exposed to opioids through legitimate medical prescriptions, while 36% began with non-prescribed opioids. This pattern highlights the complex relationship between medical practice and subsequent drug misuse, challenging simplistic narratives about the origins of addiction.
“Overall, 17.4% of people reporting fentanyl use thought that it was unlikely that they would overdose from opioid use, implying that most people using IMF recognize the heightened risk of overdose from such consumption. Although speculative, the implied awareness about risk suggests that this population may be receptive to interventions that reduce the likelihood of overdose.”, said RAND Corporation economist David Powell and University of Southern California economist Mireille Jacobson.
With the CDC estimating 65,000 deaths from synthetic opioids, including fentanyl, in the year ending June 2024, the stakes couldn’t be higher. The survey findings suggest that most people using illicitly manufactured fentanyl recognize the risk of overdose, indicating this population might be receptive to harm-reduction measures. Experts recommend expanding access to life-saving tools like naloxone and fentanyl test strips, while also addressing the underlying factors driving opioid misuse through targeted public health interventions and improved access to treatment programs.
