Fentanyl frequency hits record level in 2021

All drugs effected, including cocaine and meth

Every three months, Harm Reduction Ohio analyzes drugs found in drugs seized by law enforcement and analyzed at the state Bureau of Criminal Investigations crime labs. This analysis provides comprehensive and accurate on how the composition of Ohio’s drug supply has changed since 2014.

The charts here show the most current data on what has been found in the state’s illegal drug supply. These finding are closely correlated with overdose death. For example, when fentanyl’s presence in the drug supply increases, so do overdose death. In short, the composition of the drug supply is the only accurate predictor of overdose death in Ohio, a state that has below average drug use levels but overdose death rates that have ranked between the second and firth worst in the nation since 2014. The reason for Ohio’s high overdose death rate: a drug supply that, for unclear reasons, is one of the most adulterated in the country.

First, a quarterly look at how often fentanyl in found in drugs analyzed at the state crime labs. (Note: the state crime labs do not analyze seized marijuana, except in rare cases.)

Source: Harm Reduction Ohio analysis of Ohio BCI crime lab data.

The high level of fentanyl found in the fourth quarter of 2021 is worrisome and could foreshadow an increase in overdose death. Both drug seizure data and mortality data are limited for the fourth quarter (it takes time to collect this information), so the fourth quarter numbers may not be so extreme when complete data is available. Still, it’s concerning. Even when all four quarters are combined for more robust analysis, the drug seizure data show the highest fentanyl frequency of any year in Ohio history — and that’s saying something.

Source: Harm Reduction Ohio analysis of Ohio BCI crime lab data.

It’s worth noting how closely fentanyl frequency correlates with overdose death frequency in Ohio. In 2020, Ohio had a record high level of fentanyl — and a record high level of overdose death (5,017 deaths of Ohio residents). In 2021, fentanyl frequency is a little higher — and overdose death are are track to reach 5,300 when the final tally is completed in late summer of 2022.

What’s changed dramatically is (1) what drugs Ohio residents are using and (2) the share of fentanyl found in each drug.

As most people know, when the government cracked down on prescription opiates a decade ago, consumers were pushed into illegal opioid markets for heroin and, later, fentanyl and its analogs. The National Survey on Drug Use and Health, a federal project that surveys about 2,000 Ohioans a year on their drug use and mental health, shows general changes in drug use patterns. But the drug seizure data shows with even greater timeliness and precision what drugs people are buying, selling and using. Law enforcement agencies from across Ohio send about 50,000 samples of seized drugs to the state crime lab to analyze every year.

Sadly, the intended purpose of seizing these drugs is to persecute people who buy, use and sell prohibited drugs. However, the scientific testing of these seized has the value of telling us what’s actually in our illegal drug supply and how that changes over time. You can see above how fentanyl has been found in a growing share of seized drugs (excluding marijuana, which is not tested). Now take a look at how the frequency of the other major illegal drugs — meth, cocaine and heroin — have changed dramatically in Ohio since 2014.

Heroin’s place in Ohio’s drug supply has plummeted, likely because use has declined (for fear of overdose) and because heroin has been displaced almost entirely by fentanyl and its analogs.

During this time, cocaine’s presence has been fairly constant while methamphetamine has become the dominant drug seized in Ohio. Indeed, nearly half of all drugs seized by police in Ohio contained meth! This is truly amazing, especially since Ohio has never been a heavy meth-using state compared to other states such as Iowa and New Mexico. Meth use in Ohio has increased in recent years, but it still is lower than the national average.

One reason meth is popular is that it is the cheapest drug on the market — easy and inexpensive to make, long-lasting and inexpensive to buy. (By contrast, cocaine is the most expensive illegal drug.)

Meth overdose deaths have soared in Ohio, from about 59 in 2014 to about 1,400 in 2021. That’s an amazing large and fast increase in death. (Charts showing Ohio overdose deaths for all drugs are here.)

Just as interesting, a recent study using Ohio mortality and drug seizure data from 2014- 2019 found that increase in meth deaths were not correlated to the increase in meth seizures. But the soaring deaths were highly correlated to increases in meth-fentanyl seizures. In other words, fentanyl appears to be killing meth users, many of whom would have little or no tolerance built up to fentanyl doses. In other words, a little fentanyl may be killing a lot of (opioid naive) meth users.

This is the same pattern that happened earlier in the cocaine supply. Fentanyl moved from a heroin adulterant into cocaine, causing cocaine-fentanyl deaths to soar to historic levels. Fentanyl’s move into meth followed its move into cocaine. (Harm Reduction Ohio has not yet had time to analysis the timing of fentanyl’s flow into benzos.) Today, about 80% of deaths involving cocaine meth and benzos also involve fentanyl or an analog. About 90% of deaths involving heroin also involve fentanyl.

These charts show the share of heroin, cocaine and meth seizures in Ohio that also contained fentanyl or an analog.

Anyone who uses any drug in Ohio (excluding cannabis) or knows somebody who does should carry naloxone, the opioid overdose-reversing drug. Too many people who use cocaine and meth think they’re safe because they don’t use opioids. This is a false and deadly belief. Most overdose deaths involving cocaine, meth and benzos are really fentanyl deaths — and can be reversed with naloxone.

You can order naloxone free here from Harm Reduction Ohio. We’ll send it to you promptly in a plain envelope. An average of 15 Ohio residents die of accidental drug overdoses every day, seven days a week, 365 days a year. Drug adulteration caused by the drug war is driving this catastrophe. Protect yourself and others.

— Dennis Cauchon, President, Harm Reduction Ohio

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