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Deaths involving synthetic opioids, such as fentanyl, increased from roughly 3,000 in 2013 to more than 30,000 in 2018. This book provides readers with insights intended to improve their understanding of the synthetic opioid problem.

Researchers from the Homeland Security Operational Analysis Center evaluated publicly available data to better understand consumption and supply of illegally imported synthetic opioids. In this report, they provide their findings and recommendations.

Patterns and consequences of opioid use are changing dramatically. Researchers provide a nuanced assessment of America's opioid ecosystem, highlighting how leveraging system interactions can reduce addiction, overdose, suffering, and other harms.

The synthetic opioid surge in the United States is a public health emergency. Synthetic opioids, principally fentanyl, were reported in more than 31,000 fatal overdoses, or two-thirds of all opioid-involved deaths, in 2018. In less than six years, the number of fatal overdoses involving synthetic opioids in the United States has risen tenfold, surpassing drug overdoses for heroin or prescription opioids by a factor of two. Perhaps even more troubling is the possible diffusion of synthetic opioids into non-opioid markets. In this report, the authors examine mortality data at the state level across several drug classes to better understand the evolution and concentration of overdose fatalities in the United States. They also analyze drug seizures of fentanyl and fentanyl analogs across states and over time to determine the overlap between supply-side indicators and state-level mortality data. The authors report three main findings. First, overdose deaths involving synthetic opioids and certain supply-side indicators of synthetic opioids have increased over time but remain concentrated in certain states. Second, there have been sharp increases in the share of heroin or cocaine overdoses that involve synthetic opioids; furthermore, there appears to have been an absolute decline in fatal overdoses involving heroin without synthetic opioids in a few states. Third, a substantial share of cocaine overdoses also mention synthetic opioids, suggesting that people who use cocaine are increasingly exposed to these drugs. The authors conclude that drug policy needs to account for how rapidly these potent opioids are upending the old order.

Changing patterns in drug use and supply can affect the well-being and development of Asian countries in many ways. RAND researchers discuss the shifting drug policy landscape in Asia, with a special focus on the Philippines, Thailand, and China.