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The number of deaths from overdose of synthetic opioids has trended upward over time

• The national rate of synthetic opioid deaths was 6.2 per 100,000 in 2016 and 9 per 100,000 in 2017.

Trends in synthetic opioid seizures are evolving

• The number of seizures containing fentanyl and related substances is increasing over time.
• Many of the new fentanyl analogs reported in National Forensic Laboratory Information System data have never been reported in drug markets until now.
• Variation in drug seizure content suggests that different regions might be supplied by different sources.

The supply and trafficking of synthetic opioids differ from those for other drugs

• Synthetic opioids are produced in independent laboratories and are highly potent relative to their weight. They are readily available online.
• Online vendors regularly use the postal or other private consignment couriers to transmit packages.
• Online vendors often assess the risk of interdiction as being low and even offer to reship an order at no cost should a package be lost, stolen, or interdicted.

Additional information is needed on the chemicals associated with cutting and packaging of synthetic opioids for retail

• The majority of product on offer from retailers overseas is reported to be highly pure.
• Most of the product listings sold in online marketplaces are for powder formulation.
• Two-thirds of analyzed fentanyl cases reported to the National Forensic Laboratory Information System contain no other drug mixtures. However, about a quarter of fentanyl seizures in recent years also contain heroin, followed by other opioids at 4 percent.

The opioid overdose crisis has continued to accelerate in recent years because of the arrival of potent synthetic opioids, such as fentanyl and related substances. Although several synthetic opioids have legitimate medical applications, the majority of overdoses are due to illicitly manufactured imports. Researchers from the Homeland Security Operational Analysis Center evaluated publicly available data to better understand the dimensions of the consumption and supply of these substances. They performed four tasks designed to gain insight into this new and quickly evolving phenomenon: (1) They evaluated trends in overdoses across regions and over time. Understanding where overdoses due to synthetic opioids occur provides a rough proxy for where law enforcement should prioritize screening efforts for packages that enter the country destined for such markets. (2) They evaluated the supply of fentanyl and related substances using public data from state and local forensic laboratories that report to national systems. The authors note a relationship between lab exhibits and fatal overdoses across regions and over time. (3) They examined the online markets for synthetic opioids. The team collected quantitative and qualitative data from online marketplaces and vendors to better understand what supply and concealment mechanisms vendors use when shipping product to the United States. (4) They evaluated the adulterants and other bulking agents used in retail distribution. There are limitations to each of these approaches, and the authors provide caveats to interpreting their findings.

• Chapter One

  Introduction

• Chapter Two

  Emerging Trends in Fatal Synthetic Opioid Overdoses

• Chapter Three

  The Evolution of Synthetic Opioid Seizures

• Chapter Four

  Supply and Trafficking Methods for Synthetic Opioids

• Chapter Five

  Chemicals Associated with Cutting and Packaging Synthetic Opioids for Retail

• Chapter Six

  Conclusions and Recommendations