A new study finds that illegal opioid and fentanyl use were higher under the Biden administration than previously reported.
A June national survey of 1,515 adults found that 11% reported using illegally manufactured opioids within the previous year, including 7.5% who admitted to illicit fentanyl use. That’s the equivalent of more than 28 million and 19 million people, respectively, out of 258.4 million adults nationwide.
Published Friday in JAMA Health Forum, the study noted that the National Survey on Drug Use and Health estimated a dramatically lower number, that only 0.3% of U.S. adults used illicit fentanyl in 2022, with the share declining in 2023.
Study co-authors David Powell of the RAND Corp. and Mireille Jacobson of the University of Southern California wrote that the findings highlight “the need for more timely and accurate data to inform policy and intervention strategies” for opioid abuse.
“We find much higher rates than existing survey evidence, which is especially surprising, given that our survey was fielded during a time when overdose death rates were declining at unprecedented rates,” Mr. Powell told The Washington Times. “We also found that many people with recent illicit opioid use understood the risk of overdosing. That would imply that improving treatment access and helping more people find appropriate treatment would potentially be efficient policy goals.”
He said further government-funded research is necessary to understand trends in the opioid crisis and confirm the findings.
According to multiple reports, the opioid crisis accelerated as more people abused drugs during the coronavirus pandemic lockdowns. The study noted that nearly half a million Americans have died from opioid overdoses over the past five years.
Drug users transitioned from abusing prescription opioids like oxycodone to heroin in the early 2010s. The study notes that they shifted to fentanyl, a synthetic variant 50 times stronger than heroin, a few years later.
In an invited commentary published Friday alongside the findings, three public health researchers said the study confirms that government surveys have failed to capture the evolution of the opioid crisis into more powerful variants. They blamed the federal government’s failure to update its data-collection methods.
“We find the higher figure easier to reconcile with past estimates of the size of the heroin market, and with evidence that [illegally manufactured fentanyl] has not only largely displaced heroin from its traditional markets, but also expanded beyond, for example, into counterfeit pills,” researchers Jonathan P. Caulkins, Greg Midgette and Peter Reuter wrote in the commentary.
Reached for comment, other experts not connected to the study said it calls for a renewed public health response to the spread of illegal fentanyl.
“As a general matter, we have known for more than 20 years that typical federal government surveys grossly understate the prevalence of illicit drug use,” said Keith Humphreys, a Stanford University psychologist and addiction researcher. “I don’t know if this study is correct, but it’s important because it uses an innovative method to assess how much fentanyl Americans are using, and we need that because current methods are pretty low quality.”
The Trump administration has directed billions of dollars toward reducing opioid overdoses, as did the Biden White House, but with different strategies.
In 2017, the first Trump administration declared the opioid crisis a public emergency and secured funding to combat addiction. Those initiatives focused on reducing illicit opioid availability, preventing abuse and increasing access to treatment and recovery services.
The Biden administration prioritized harm reduction strategies, expanding access to fentanyl test strips and the overdose-reversal drug naloxone. The Biden team also supported decriminalizing substance abuse and regulating drug use.
During his first month back in office, President Trump cited illegal fentanyl flowing into the U.S. to justify his plans to impose sweeping tariffs on other nations.
“It’s early in Trump’s second term, but we expect to see similar policies as before,” said Justin Todd, a Michigan-based addiction expert and co-founder of AddictionResource.net. “We expect he will not be decriminalizing illicit drug use and will go hard on prosecuting drug dealers.”
In a statement emailed to The Times, the federal Substance Abuse and Mental Health Services Administration noted that Health and Human Services Secretary Robert F. Kennedy Jr. renewed the public health emergency for opioids in March.
The agency, a branch of HHS, urged opioid abusers to visit findtreatment.gov or call the federal 988 lifeline for help.
“HHS takes its responsibility in protecting Americans seriously and will continue to focus on prevention, treatment and recovery efforts that aim to Make America Healthy Again,” a SAMHSA spokesperson said. “Importantly, we know that treatment of substance use disorders works, but too often people who could benefit from life-saving therapies, like medications for opioid use disorder, do not know where to access these services.”
