By David Powell; Mireille Jacobson

IMPORTANCE Illicit opioids, particularly illicitly manufactured fentanyl (IMF), are major contributors to overdose deaths in the US. Understanding the prevalence and characteristics of illicit opioid use is crucial for addressing the opioid crisis. OBJECTIVE To estimate the prevalence of illicit opioid use, including IMF, and initial opioid exposure among those reporting illicit opioid use. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted using an online survey with targeted demographic quotas from June 10, 2024, to June 17, 2024. A total of 1515 participants aged 18 years and older from the US completed the survey. The analysis was conducted between June 30, 2024, and February 13, 2025. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported illicit opioid use within the past 12 months. Secondary outcomes included initial exposure to opioids and perceived likelihood of overdose. Logistic regression was used to analyze associations with demographic and geographic factors. RESULTS A total of 1515 respondents completed the survey, including 770 female individuals (50.8%), 20 American Indian or Alaska Native (1.3%), 101 Asian or Pacific Islander (6.7%), 215 Black (14.2%), 1087 White (81.7%), and 24 multiracial (1.6%); 186 (12.3%) were aged 18 to 24, 242 (16.0%) 25 to 34, 327 (21.6%) 35 to 44, 280 (18.5%) 45 to 54, 281 (18.5%) 55 to 64, 139 (9.2%) 65 to 74, and 60 (4.0%) 75 to 84 years. Among this sample, 166 (10.96%; 95% CI, 9.38%-12.52%) reported nonprescription opioid use within the past 12 months, including 114 (7.52%; 95% CI, 6.20%-8.85%) of the 1515 respondents reporting IMF use. Among those reporting nonprescription opioid use within the past 12 months, 65 (39.16%; 95% CI, 31.73%-46.58%) reported that their first opioid use involved opioids prescribed to them, whereas 60 (36.14%; 95% CI, 28.84%-43.45%) reported that their first use involved prescription opioids not prescribed to them. Only 41 (24.70%; 95% CI, 18.14%-31.26%) answered that their first exposure involved illicit opioids. Seventy-one (4.69%; 95% CI, 3.62%-5.75%) of all respondents reported that it was very likely they would have an overdose due to opioid use. This rate increased to 33.33% (95% CI, 24.68%-41.99%) among those who had used IMF within the past 12 months. Illicit opioid use was higher among men, Black respondents, and younger age groups. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study indicate a higher prevalence of illicit opioid use than previously reported, highlighting the need for more timely and accurate data to inform policy and intervention strategies.

JAMA Health Forum; 2025

By Thorn and Burson Insights, Data & Intelligence

Since 2019, Thorn has focused on amplifying youth voices to better understand their digital lives, with particular attention to how they encounter and navigate technologyfacilitated forms of sexual abuse and exploitation. Previous youth-centered research has explored topics such as child sexual abuse material (CSAM)1 —including that which is self-generated (“SG-CSAM”)—nonconsensual resharing, online grooming, and the barriers young people face in disclosing or reporting negative experiences. Thorn’s Emerging Threats to Young People research series aims to examine emergent online risks to better understand how current technologies create and/or exacerbate child safety vulnerabilities and identify areas where solutions are needed. This report, the first in the series, sheds light specifically on young people’s perceptions of and experiences with deepfake nudes. Future reports in this initiative will address other pressing issues, including sextortion and online solicitations. Drawing on responses from a survey of 1,200 young people aged 13-20, this report explores their awareness of deepfake nudes, lived experiences with them, and their involvement in creating such content. Three key findings emerged from this research: CSAM Any visual depiction of sexually explicit conduct involving a person less than 18 years old 1. Young people overwhelmingly recognize deepfake nudes as a form of technology-facilitated abuse that harms the person depicted. Eighty-four percent of those surveyed believe that deepfake nudes cause harm, attributing this largely to the emotional and psychological impacts on victims, the potential for reputational damage, and the increasingly photorealistic quality of the imagery, which leads viewers to perceive—and consume—it as authentic. 2. Deepfake nudes already represent real experiences that young people have to navigate. Not only are many young people familiar with the concept, but a significant number report personal connections to this harm—either knowing someone targeted or experiencing it themselves. Forty-one percent of young people surveyed indicated they had heard the term “deepfake nudes,” including 1 in 3 (31%) teens. Additionally, among teens, 1 in 10 (10%) reported personally knowing someone who had deepfake nude imagery created of them, and 1 in 17 (6%) disclosed having been a direct victim of this form of abuse. 3. Among the limited sample of young people who admit to creating deepfake nudes of others, they describe easy access to deepfake technologies. Creators described access to the technologies through their devices’ app stores and accessibility via general search engines and social media

El Segundo, CA: Thorn, 2025. 32p.