This Week’s Focus: Fentanyl

This week’s briefing highlights recent reports and emerging data indicating a shift in the illicit fentanyl market. A recent study published in Science reported that changes in fentanyl availability are likely attributed to a “supply shock” caused by disruptions in precursor chemical sourcing and intensified enforcement efforts.

Following this study, our briefing this week includes two NDEWS Special Reports featuring data from emergency medical service (EMS) encounters involving nonfatal fentanyl overdoses and a future trends model predicting nonfatal fentanyl overdoses through December 2026 using the Prophet Model and EMS data sourced from biospatial.io.

Additionally, the latest Web Monitoring Report from our NDEWS Web Monitoring Team on fentanyl is included, with data gathered from recent Reddit conversations showing a decreasing trend consistent with findings reported in the Science study.

Illicit drug markets can adapt quickly to supply disruptions, often introducing new substances or altering existing formulations. It's imperative that real-time surveillance systems and networks like NDEWS stay vigilant for monitoring these shifts and providing timely insights to inform our communities.

As always, we welcome your input.

Out of 229,083 EMS encounters involving nonfatal fentanyl overdoses from January 1, 2023 to December 31, 2025, 101,518 (44.3%) occurred in Western states, 23,975 (10.5%) in Midwestern states, 79,676 (34.8%) in Southern states and 23,914 (10.4%) in Northeastern states. To view the entire Special Report from the weekly briefing, click here.

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Based on the data just presented involving nonfatal fentanyl overdoses, we applied a Prophet model to estimate the trend through December 2026. As shown above, we are projecting a statistically significant decrease in EMS encounters involving nonfatal fentanyl overdoses through December 2026 that warrants future public health monitoring. To view the entire Special Report from the weekly briefing, click here.

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Why are we reporting on this? Fentanyl continues to be a primary focus of public health surveillance due to its role in the overdose crisis. However, recent data analyzed by the NDEWS Web Monitoring Team shows a notable decline in the volume of Reddit discussions concerning fentanyl over the past six months. This trend aligns with a broader national decrease in fentanyl-related overdoses, a phenomenon recently detailed in a report in the journal Science. As noted in the accompanying article in this briefing, the Science report specifically utilizes Reddit data to track these shifting patterns, suggesting that online discourse may serve as a leading indicator for real-world public health outcomes.

What is Fentanyl? Fentanyl is a synthetic opioid of high potency, estimated to be 50 to 100 times stronger than morphine. While pharmaceutical fentanyl is used for severe pain management, illicitly manufactured fentanyl—often found in powder form or as counterfeit pills—dominates the illicit market. It is frequently introduced into other drug supplies, such as cocaine, methamphetamines, and counterfeit benzodiazepines, posing a severe risk of lethal respiratory depression.

Public Health Impacts: Reddit discussants consistently describe severe health consequences related to fentanyl use and the challenges of cessation. Multiple commenters report intense physical withdrawal symptoms, specifically mentioning severe gastrointestinal distress, profound insomnia, and overwhelming cravings. There is also a recurring pattern of psychological distress tied to the fear of accidental exposure; commenters across various subreddits express anxiety about fentanyl being present in non-opioid substances like cannabis concentrates (wax) or psychedelics. Furthermore, discussants report significant stress regarding false positive drug tests, which can have serious implications for those under legal or employment-related monitoring.

How is it Being Discussed? Despite the overall reduction in comment frequency, active discussions focus heavily on treatment and supply volatility. Reddit commenters frequently share advice on the use of fentanyl test strips (FTS), with many seeking clarification on interpreting faint test lines. There is significant discourse regarding the reliability of drug screening methods, specifically the detection windows of fentanyl in saliva versus urine. Discussants also compare the effects of pharmaceutical-grade fentanyl patches to illicitly manufactured fentanyl and its various analogs. When discussing recovery, many users share strategies for managing withdrawal, frequently citing the use of kratom and marijuana as treatment tools. Finally, there is a persistent thread of skepticism regarding the purity of traditional drugs, with commenters frequently questioning if products like "wax" or "Adderall" have been adulterated with synthetic opioids.

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A recently published study in Science by Vangelov et al. analyzes the trend of fatal overdoses involving synthetic opioids, most notably fentanyl. The study states that fatal overdoses from synthetic opioids rose 25-fold over the past 15 years to a peak of 76,000 deaths in 2023 but declined by one-third by the end of 2024. The study investigates the cause of the recent trend through policy changes, fentanyl purity, and Reddit discussions in an effort to determine the cause of the downward trend. Read the full study here.

A recently published article in Psychology Today’s Addiction Outlook by NDEWS SAG Member Mark Gold discusses the study above published in Science about the “supply shock” in the illicit fentanyl trade. The article emphasizes that the sharp reduction in fentanyl-related fatal overdoses is unprecedented and highlights how supply chain disruptions can have immediate life-saving effects. However, the article warns that this trend may be temporary because drug markets can adapt quickly. Read the full article here.

A recently published study in JAMA Health Forum by Dahlen et al. examines the association between the proportion of fentanyl reports in illicit drug seizures and opioid overdose deaths during periods of rising and falling mortality. A secondary analysis of state-month-level panel data was conducted from January 2018 to September 2024, including all 50 US states and Washington, DC. The results from the study concluded that from a peak of opioid overdose deaths in the summer of 2023, they had declined by 50% by the fall of 2024. This was accompanied by a decline in the fentanyl reports as a proportion of the total illicit drug seizures from 28.8% to 23.2%. The study results suggest that current decline in the proportion of fentanyl reports in illicit drug seizures is associated with 9.2% of the total observed decline in mortality. Read the full study here.

A recently published study in Drug and Alcohol Reports by Yuen Choo et al. analyzes 205 patients treated for fentanyl-related overdoses across rural health systems. The retrospective cohort study using emergency medical record data revealed significant morbidity and mortality from November 2021 to October 2022. Read the full study here.