By Lauren J. Tanz, R. Matt Gladden, Amanda T. Dinwiddie, Kimberly D. Miller, Dita Broz, Eliot Spector, Julie O’Donnell

Summary

What is already known about this topic?

More than 109,000 drug overdose deaths occurred in the United States in 2022; nearly 70% involved illegally manufactured fentanyls (IMFs). Data from the western United States suggested a transition from injecting heroin to smoking IMFs.

What is added by this report?

From January–June 2020 to July–December 2022, the percentage of overdose deaths with evidence of smoking increased 73.7%, and the percentage with evidence of injection decreased 29.1%; similar changes were observed in all U.S. regions. Changes were most pronounced in deaths with IMFs detected, with or without stimulant detection.

What are the implications for public health practice?

Strengthening and expanding public health and harm reduction services to address overdose risk with smoking and other noninjection routes might reduce deaths.

Preliminary reports indicate that more than 109,000 drug overdose deaths occurred in the United States in 2022; nearly 70% of these involved synthetic opioids other than methadone, primarily illegally manufactured fentanyl and fentanyl analogs (IMFs). Data from the western United States suggested a transition from injecting heroin to smoking IMFs. CDC analyzed data from the State Unintentional Drug Overdose Reporting System to describe trends in routes of drug use in 27 states and the District of Columbia among overdose deaths that occurred during January 2020–December 2022, overall and by region and drugs detected. From January–June 2020 to July–December 2022, the percentage of overdose deaths with evidence of injection decreased 29.1%, from 22.7% to 16.1%, whereas the percentage with evidence of smoking increased 73.7%, from 13.3% to 23.1%. The number of deaths with evidence of smoking increased 109.1%, from 2,794 to 5,843, and by 2022, smoking was the most commonly documented route of use in overdose deaths. Trends were similar in all U.S. regions. Among deaths with only IMFs detected, the percentage with evidence of injection decreased 41.6%, from 20.9% during January–June 2020 to 12.2% during July–December 2022, whereas the percentage with evidence of smoking increased 78.9%, from 10.9% to 19.5%. Similar trends were observed among deaths with both IMFs and stimulants detected. Strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other non-injection routes, might reduce drug overdose deaths.

Morbidity and Mortality Weekly Report; February 15, 2024

By Thomas Hofmarcher, Anne Leppänen, Anna Månsdotter, Joakim Strandberg, Anders Håkansson

Background: Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. Methods: A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. Results: The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. Conclusion: Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.

International Journal of Drug Policy, Volume 123, January 2024, 104259

By Jennifer J. Carroll

Against the backdrop of a post-Soviet state set aflame by geopolitical conflict and violent revolution, Narkomania considers whether substance use disorders are everywhere the same and whether our responses to drug use presuppose what kind of people those who use drugs really are. Jennifer J. Carroll's ethnography is a story about public health and international efforts to quell the spread of HIV. Carroll focuses on Ukraine where the prevalence of HIV among people who use drugs is higher than in parts of sub-Saharan Africa and unpacks the arguments and myths surrounding medication-assisted treatment (MAT) in Ukraine. What she presents in Narkomania forces us to question drug policy, its uses, and its effects on "normal" citizens. Carroll uses her findings to explore what people who use drugs can teach us about the contemporary societies emerging in post-Soviet space. With examples of how MAT has been politicized, how drug use has been tied to ideas of "good" citizenship, and how vigilantism towards people who use drugs has occurred, Narkomania details the cultural and historical backstory of the situation in Ukraine. Carroll reveals how global efforts supporting MAT in Ukraine allow the ideas surrounding MAT, drug use, and HIV to resonate more broadly into international politics and echo into the heart of the Ukrainian public.

Ithaca, NY; London: Cornell University Press Ithaca and London, 2019. 251p.

By Tibor Kiss & Ákos Szigeti

The process of illicit drug trafficking on darknet markets is highly affected by various trust factors. Although the factors potentially affecting customers’ risk perception can be identified based on previous research, cyber criminology has not produced empirical research ranking the importance of the specific factors. This study was designed to fill this gap by developing a tool that measures the importance of the various trust factors. To test out the measurement tool, a large-scale survey with projective situational questions was conducted among university students in Hungary. The sample (n = 5481) was compiled to include potential darknet market customers, respondents with above-average computer skills needed to access the darknet, and taking into account that university students are a group of society particularly exposed to drug consumption. The end product of this research is a trust matrix ranking the factors affecting illicit drug purchases on darknet markets. Among the factors, the survey’s target group ranked reliable and undamaged delivery of goods and the reliability of vendors as the most important. The measurement tool developed in this research will facilitate further criminological research on vendor reputation. Its findings also point to the need for further research on delivery providers and predict that influencing the delivery-related risk perception of potential customers could effectively reduce demand.

May 2023 European Journal on Criminal Policy and Research

By Charles Fain Lehman

While most Americans have focused on the Covid-19 pandemic, the nation’s other great epidemic has continued to burn. Drug overdoses now claim the lives of over 100,000 Americans every year, a rate that appears likely to continue or grow for the foreseeable future. While the crisis once was concentrated predominantly in rural, white communities, the introduction of novel synthetic opioids, particularly fentanyl, into the illicit drug supply has spread overdoses across urbanizations. Today, small-town and big-city leaders alike desperately need tools to fight back against the drug crisis. It can often seem as though drug policy is outside the ambit of local leaders, who lack the capacity to go after international traffickers or spend trillions of dollars on care. But local government, as the closest entity to the front lines of the crisis, plays a vital role in addressing it. This paper, therefore, explores options for local policymakers to respond to the drug crisis. In particular, it considers six frequently discussed local-scale policies: • Naloxone access and distribution • Investing in treatment capacity • Drug court programs • Wastewater tracking • Supervised consumption sites • Drug market interventions For each policy, this paper examines the evidence, offers estimates of costs, and provides caution where necessary. The overall goal is to give local policymakers a better understanding of what tools they have to more effectively tackle the other health crisis in their communities.  

New York: The Manhattan Institute, 2022. 19p.

Edited by Bradley D. Stein, Beau Kilmer, Jirka Taylor, Mary E. Vaiana

Opioids play an outsized role in America's drug problems, but they also play a critically important role in medicine. Thus, they deserve special attention. Illegally manufactured opioids (such as fentanyl) are involved in a majority of U.S. drug overdoses, but the problems are broader and deeper than drug fatalities. Depending on the drugs involved, there can be myriad physical and mental health consequences associated with having a substance use disorder. And it is not just those using drugs who suffer. Substance use and related behaviors can significantly affect individuals' families, friends, employers, and wider communities. Efforts to address problems related to opioids are insufficient and sometimes contradictory. In this 600-page report, researchers provide a nuanced assessment of America's opioid ecosystem, highlighting how leveraging system interactions can reduce addiction, overdose, suffering, and other harms. At the core of the opioid ecosystem are the individuals who use opioids and their families. Researchers also include chapters on ten major components of the opioid ecosystem: substance use disorder treatment, harm reduction, medical care, the criminal legal system, illegal supply and supply control, first responders, the child welfare system, income support and homeless services, employment, and education.

Santa Monica, CA: RAND, 2023. 618p.

By Xiguang Liu , Mendel E. Singer 

The combination of opioids and cocaine has been increasingly implicated in overdose fatalities, but it is unknown how much is intentional vs. fentanyl-adulterated drug supply. 2017–2019 data from the nationally representative National Survey on Drug Use and Health (NSDUH) was used. Variables included sociodemographics, health, and 30-day drug use. Opioid use captured heroin, and prescription pain reliever use not according to own doctor. Modified Poisson regressions were used to estimate prevalence ratios (PRs) for variables associated with opioid and cocaine use. Among the 167,444 responders, 817(0.49%) reported use of opioids on a regular or daily basis. Of these, 28% used cocaine ≥1 of prior 30 days, 11% >1 day. Of 332(0.20%) who used cocaine on a regular/ daily basis, 48% used opioids ≥1 of prior 30 days, 25% >1 day. People with serious psychological distress were >6 times as likely to use both opioids and cocaine regularly/daily (PR = 6.48; 95% CI = [2.82–14.90]) and people who have never been married were 4 times as likely (PR = 4.17; 95% CI = [1.18–14.75]). Compared to those living in a small metropolitan region, people living in a large metropolitan region were >3 times as likely (PR = 3.29; 95% CI = [1.43–7.58]) and the unemployed were twice as likely (PR = 1.96; 95% CI = [1.03–3.73]). People with post-high school education were 53% less likely to use opioids and cocaine at least occasionally (PR = 0.47; 95% CI = [0.26–0.86]). People who use opioids or cocaine commonly choose to use the other. Knowing the characteristics of those most likely to use both should guide interventions for prevention and harm reduction.  

Preventive Medicine Reports 33 (2023) 102227

By Marie Claire Van Hout and Tim Bingham

This research aimed to assemble an evidence base around perceived anti-social behaviour associated with the provision of drug treatment in Dublin’s city centre, upon which to build a strategic response incorporating short/medium/long term goals and actions within the area. It will be used to guide discussions on how to reduce visibility of drug related public nuisance, improve public perceptions of safety in the area and provide comprehensive, safe, effective and appropriate treatment services within a series of short, medium and long-term strategies.

Dublin:Strategic Response Group, 2012. 187p.