Thread by @jeppdx

3 points discussed recently shown in data:
1)Youth are more affected by illicit fentanyl, often sold to them in fake pills disguised as legit Rx.
2)Rx Opioids have very little to do with the current crisis.
3)Multiple substance use is the rule/fentanyl is increasingly in all (1)

My understanding of how these data fit together: If an expert/professional out there educates me where I'm wrong, that would be welcome. The almost final 2020 CDC provisional data at detail is available now. 2020 had 92K unique deaths, 57K of which 'involved' fentanyl. (2)

I have interpreted the 6 drug types I used as shown. It's not perfect (ie: Rx includes methadone, fentanyl includes tramadol, etc.), but is best I can do with the data available, not too many categories, and directionally accurate. (3)

Drug types are Multiple Cause of Death data (MCD), which means multiple drugs in one unique death. That's why they don't add up to the total of 92K in 2020; they are not mutually exclusive. Fentanyl = 62% Meth = 26%, Coke = 21%, Rx Opioids = 18%, Heroin = 14%, Benzos = 13% (4)

Examine drug involvement as a % of all drug deaths by age group shows that youth age 15-24 are affected by fentanyl far more than total population (76% v 62%). When you back out the other listed drug types to get 'fentanyl only', you see similar difference (38% v 22%) (5)

The 38% of youth drug death (which is +50% in 2020) that is 'fentanyl only' is one area where the fake pill impact is more evident...youth are less likely to seek fentanyl, less knowledgeable about the risks, and probably more likely to pass pills in HS and college. (6)

Looking at Rx Opiods, if only 18% involvement of all ages/all drug deaths wasn't enough to make it clear that Rx is not the culprit, when you take out fentanyl from Rx opioids, you're at only 8% of total, and down further to only 4% when you remove all the other listed drugs. (7)

Which takes us to 3rd point: Multiple subst. are often in play. With illicit fentanyl in the drug supply, and hard to dose safely, combinations become more lethal. In particular, Benzos + Fentanyl is quite toxic combo. Add F to these other substances and deaths are 2-3X. (8)

Outside of interdiction efforts, treatment & recovery, harm reduction measures, we'd be better served if we had increased fake pill awareness & mental health for youth,stopped focusing on Rx as the problem, and better death and surveillance reporting of multiple substances. (9)

@SongforCharlie focuses on awareness of risks of today's drugs oft disguised as legit medicine;so youth know they can't solve real stress w fake pills. Free resources available @ songforcharlie.org Constructive input on this math welcome; many greater experts out there.(end)

One other comment re: illicit fentanyl vs Rx I understand it is impossible to distinguish between the two with today’s toxicology tech (or maybe ever). A study done in 38 states of 18k Deaths showed 89% of fentanyl was illicit onlinelibrary.wiley.com/doi/pdf/10.111…

That study required evidence beyond the tox report: scene and witness reporting. It seems that work like this would not only help the continuing false myth of real Rx as culprit, but also unpack the so called ‘intent’ that goes with the fact that 98% of these non suicide

..deaths are called unintentional or undetermined….when in fact a material portion should be called an assault if the user was given something lethal without their knowledge deceptively…like fake pills.

While that’s broken, it really shows ignorance, willful deceit, or at the least a horrible lack of leadership to lump all fentanyl deaths in with Rx, as many states do (CO, CA, WI?, other..). I was told by CA Health they do this because they can’t tell Rx and illicit apart. Weak.

And cdc response to this approach: count it all as illicit and call it out separately. States should follow! cdc.gov/mmwr/volumes/7…