By Tse Yang Lim , Huiru Dong , Erin Stringfellow , Zeynep Hasgul , Ju Park , Lukas Glos , Reza Kazemi , Mohammad S Jalali 

Fentanyl and its analogs contribute substantially to drug overdose deaths in the United States. There is concern that people using drugs are being unknowingly exposed to fentanyl, increasing their risk of overdose death. This study examines temporal trends and spatial variations in the co-occurrence of fentanyl with other seized drugs.

Methods

We identified fentanyl co-occurrence (the proportion of samples of non-fentanyl substances that also contain fentanyl) among 9 substances or substance classes of interest: methamphetamine, cannabis, cocaine, heroin, club drugs, hallucinogens, and prescription opioids, stimulants, and benzodiazepines. We used serial cross-sectional data on drug reports across 50 states and the District of Columbia from the National Forensic Laboratory Information System, the largest available database on the U.S. illicit drug supply, from January 2013 to December 2023.

Findings

We analyzed data from 11,940,207 samples. Fentanyl co-occurrence with all examined substances increased monotonically over time (Mann-Kendall p < 0.0001). Nationally, fentanyl co-occurrence was highest among heroin samples (approx. 50%), but relatively low among methamphetamine (≤1%), cocaine (≤4%), and other drug samples. However, co-occurrence rates have grown to over 10% for cocaine and methamphetamine in several Northeast states in 2017–2023.

Interpretation: 

Fentanyl co-occurs most commonly with heroin, but its presence in stimulant supplies is increasing in some areas, where it may pose a disproportionately high risk of overdose.

Lancet Reg Health Amicas, 2024 Sep 27;39:100898. doi: 10.1016/j.lana.2024.100898

By Aili Malm, Nicholas Perez, Michael D. White

This publication represents the final research report of California State University, Long Beach’s (CSULB) evaluation of an intelligence-led problem-oriented policing (POP) project to better understand and address illicit fentanyl distribution networks in Long Beach, CA. The goals of this study were to: (1) employ problem-oriented policing to drive efforts to identify and disrupt fentanyl distribution networks in Long Beach, CA, and (2) use intelligence analysis to identify high-level distributors for investigation. To achieve these goals, researchers worked with a newly hired intelligence analyst and Long Beach Police Department (LBPD) Drug Investigation Section (DIS) detectives to improve their fentanyl distribution network investigations. The intervention included POP training, intelligence analyst support [cellular phone extractions, open-source intelligence (OSINT), social network analysis (SNA), etc.], and weekly interactions between the analyst and the research team. To assess the effectiveness of the project, we conducted both process and outcome evaluations. Primary data sources include: (1) interviews of detectives and the analyst; (2) DIS administrative data; (3) network data from three fentanyl distribution cases; and (4) fentanyl-related overdose data from the LBPD and the California Overdose Surveillance Dashboard. We identified findings across multiple analyses that, when taken together, represent a persuasive collection of circumstantial evidence regarding the positive effects of the project on two important outcomes: increased DIS activity and efficiency and effective fentanyl distribution network disruption. While fentanyl-related overdose rates did decrease substantially over the course of the project, there is no conclusive evidence that the project led to the reduction. The effects of COVID-19, the defund movement following George Floyd’s death, and the Los Angeles County District Attorney policy limiting the prosecution of drug offenses confounded our ability to draw a stronger connection between the project and enhanced DIS activity and efficiency, fentanyl distribution network disruption, and overdose rates.   

California State University, Long Beach; School of Criminology, Criminal Justice, and Emergency Management; 2024 77p. 

By Michael J. Zoorob,; Ju Nyeong Park,; Alex H. Kral,; et al

Importance: With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl-a substance that is known to drive fatal overdose-to Oregon's unregulated drug market.

Objective: To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon's unregulated drug market.

Design, setting, and participants: In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024.

Exposures: Measure 110 took effect in Oregon on February 1, 2021.

Main outcomes and measures: The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market.

Results: In this analysis, rapid spread of fentanyl in Oregon's unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], -0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result.

Conclusions and relevance: In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon's unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.  

JAMA Netw Open. 2024;7(9):e2431612. doi:10.1001/jamanetworkopen.2024.31612

By Mark McMullen

Although it is particularly pronounced in Oregon, there is no question that the fentanyl epidemic is imposing severe economic costs across the nation. The current report quantifies some of these costs and describes the state policy environment. Public policy regarding drug use is evolving rapidly in Oregon as we speak. As with all CSI does, the primary goal of this report is to educate and inform Oregonians on policy issues such as this that impact their lives. Key Findings • The economic cost of Oregon’s fentanyl crisis is more than $31 billion annually, up from $5.88 billion in 2017. • Enough fentanyl was seized last year to kill every Oregonian more than 20 times over. • Most western states have seen above-average growth in fentanyl use during recent years. Even so, Oregon’s experience stands out relative to its neighbors. Since the pandemic began, fentanyl-related overdose deaths in Oregon have increased by over 1,000%, more than in any other state. Alaska’s experience is the only one that even comes close. • Although Oregon’s decriminalization experiment cannot be blamed for all the disproportionate local impact of the fentanyl epidemic, it is clearly playing a role. When decriminalization went into effect in February 2021, Oregon ranked 38th out of 48 states with available data in the rate of fentanyl related overdose deaths. By January 2024, Oregon’s rank rose to 13th. • Many voters and policymakers quickly experienced regrets associated with the decriminalization effort and are making some efforts to improve the law. During the 2023 legislative session, legislators enacted House Bill 4002, which created a new misdemeanor for simple drug possession. The new law gives leeway to counties on how to implement it locally, and we are likely to learn much as the different programs evolve.

Greenwood Village, CO: Common  Sense Institute 2024. 

By Michael J. Zoorob, ; Ju Nyeong Park, ; Alex H. Kral,  et alBarrot H. Lambdin, PhD3; Brandon del Pozo, PhD, MPA, MA1,2

IMPORTANCE-  With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl—a substance that is known to drive fatal overdose—to Oregon’s unregulated drug market. OBJECTIVE -  To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon’s unregulated drug market. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024. EXPOSURES Measure 110 took effect in Oregon on February 1, 2021. MAIN OUTCOMES AND MEASURES The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market. RESULTS In this analysis, rapid spread of fentanyl in Oregon’s unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], −0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result. CONCLUSIONS AND RELEVANCE In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon’s unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

  JAMA Netw Open. 2024;7(9):e2431612. doi:10.1001/jamanetworkopen.2024.3161