The American fentanyl epidemic: geographic variation in mortality and policy implications.

Introduction: The American fentanyl epidemic has become the worst man-made epidemic the country has faced to date, claiming tens of thousands of lives each year. Methods: Using population-based data provided by the Centers for Disease Control and Prevention, we examined the increase in unintentional, fatal fentanyl overdose since 2005 and analyzed the geographic variation in fentanyl mortality among census divisions, states, and counties. Results: In 2022, 70 813 persons died of an unintentional fentanyl overdose, a 31-fold increase over the 2139 deaths that occurred in 2012; the age-adjusted mortality rate increased similarly. Fentanyl deaths resulted in ∼2.0-2.6 million estimated years of life lost. We estimated the economic loss to the nation resulting from premature mortality was on the order of $57-$67 billion. The impact of the fentanyl epidemic varied widely by geographic area. The mortality rate of West Virginia was 15 times greater than that of South Dakota. Conclusion: Containing the fentanyl epidemic will require new, data-driven preventive and treatment approaches, coordinated across sectors, including public health, health care, law enforcement, education, and social services. Interventions should be based upon the risk profile of geographic areas and include harm reduction activities as well as social marketing campaigns to improve public awareness of fentanyl's health risks.