Increased Intensity of Opioid Use During the Fentanyl Era

Recent research indicates that the severity of opioid consumption has escalated notably in the period marked by the proliferation of fentanyl and other synthetic opioids. While the overall prevalence of opioid use remains a concern, the focus is shifting towards understanding the intensity, or amount consumed, by individual users. A comprehensive study by Carnegie Mellon University, RAND, and the University of Maryland analyzed global data sources, including 135 pertinent studies, to examine variations in daily opioid intake across different user populations.

The findings reveal a striking variation in consumption levels: in high-price treatment settings, daily opioid intake can be below 100 morphine milligram equivalents (MME), whereas in typical illegal markets, daily use averages around 600 MME. When supply is abundant or free—such as in heroin-assisted treatment—daily consumption can reach between 1,100 and 1,800 MME. Notably, individuals engaged in treatment programs often report higher consumption intensities than those not in treatment, and recent trends suggest that consumption levels tend to be rising, coinciding with lower drug prices.

The advent of the fentanyl era complicates the landscape, as limited studies suggest that MMEs per day may be significantly higher than in previous periods. This variability has important implications for public health strategies, including overdose prevention and treatment protocols, which may need adjustment to account for higher baseline consumption levels. Moreover, the study advocates for systematic monitoring of consumption intensity in epidemiological surveillance rather than focusing solely on the number of users.

Experts suggest that gathering data on how much opioids users consume—by querying users directly and analyzing drug purity and pricing—could vastly improve understanding of consumption patterns. These insights are vital to informing policies that address supply expansion, optimize treatment approaches, and mitigate harms associated with high-intensity use of opioids, especially amid ongoing shifts in the illegal drug market.

This research underscores the urgent need to adapt current drug policies and healthcare responses to the evolving landscape of opioid consumption, particularly in the context of synthetic opioids like fentanyl that significantly alter the risk and magnitude of drug use harms.