Study: More than 115 million pills with illicit fentanyl seized in 2023

Key takeaways:

• The percentage of fentanyl-containing pills relative to all fentanyl seized by U.S. law enforcement increased from 10.3% in 2017 to 49% in 2023.
• Seizures of fentanyl in powder form rose 923%.

The number of pills containing illicit fentanyl that were seized by United States law enforcement in 2023 was 2,300 times greater than the number in 2017, according to a study published in the International Journal of Drug Policy.

In addition, researchers found that the proportion of fentanyl pills that were seized relative to the total number of fentanyl seizures more than quadrupled during this period.

“I wasn’t very surprised that the majority of fentanyl seizures are now in pill form,” Joseph J. Palamar, PhD, MPH, an associate professor in the department of population health at NYU Grossman School of Medicine, told Healio. “Fentanyl has slowly shifted to pill form over many years.”

The rise in illicit fentanyl comes as the United States continues to battle the deadly opioid crisis. According to Palamar and colleagues, 107,941 drug overdose deaths occurred in 2022, with 75% associated with synthetic opioids.

The researchers conducted a study to assess overall and regional fentanyl seizure data — taken from the High Intensity Drug Trafficking Areas (HIDTA) program — spanning from 2017 through 2023.

They found that the percentage of seizures of fentanyl in pill form relative to all fentanyl seizures increased from 10.3% in 2017 to 49% in 2023 (adjusted annual percentage change [AAPC] = 25.2; 95% CI, 17.6-33.2).

Overall, 115,562,603 fentanyl-containing pills were seized in 2023 vs. 49,657 in 2017 (AAPC = 198.7; 95% CI, 167.6-233.5).

This increase was significantly driven by seizures in pill form in the West, which jumped from 39.9% in 2017 to 77.8% in 2023 (AAPC = 8.3; 95% CI, 2.1-14.99).

Although the Midwest had a lower prevalence of pill seizures compared with the West, it experienced the largest increase across the years (AAPC = 142.2; 95% CI, 91.9-205.8), Palamar and colleagues reported.

The weight of fentanyl pills relative to the total weight of fentanyl seizures increased from 0.4% to 54.5% over the study period (AAPC = 112.6; 95% CI, 78.6-153.2).

In addition, the researchers noted that the number of seizures of powder fentanyl rose from 1,171 in 2017 to 11,980 in 2023, for an increase of 923.1% (AAPC = 47.2; 95% CI, 25.6-72.5). Although most powder seizures occurred in the South overall (n = 17,407), increases were greatest in the West (AAPC = 63.3; 95% CI, 11-140.1).

“With the drug market being flooded with fentanyl pills, there is an increased risk of people who seek pills illegally being unintentionally exposed to fentanyl,” Palamar said. “Fentanyl in pill form also appears to be shifting the way people progress in their opioid use. For years, most people who used fentanyl moved on from heroin use, but now we now have people initiating illegal opioids with fentanyl because it is in pill form.”

The researchers pointed out that HIDTA-related law enforcement efforts increased during the study period, although how much of an impact this had on the findings was unknown.

Ultimately, “we need to try our hardest to prevent people from initiating fentanyl,” Palamar said. “Most focus today is on harm reduction, which focuses on reducing harm among people who use, but we need more focus on preventing people from starting, especially as fentanyl is now mainly in pill form.”

For more information:

Joseph J. Palamar, PhD, MPH, can be reached at Joseph.Palamar@nyulangone.org.

References:

• Over 115 million pills containing illicit fentanyl seized by law enforcement in 2023. https://www.nih.gov/news-events/news-releases/over-115-million-pills-containing-illicit-fentanyl-seized-law-enforcement-2023. Published May 13, 2024. Accessed May 13, 2024.
• Palamar J, et al. Int J Drug Policy. 2024;doi:10.1016/j.drugpo.2024.104417.