Is the overdose epidemic getting worse?

Federal officials in March warned that a drug not even approved for human use, the veterinary tranquilizer xylazine, is now contributing to America’s spiraling overdose crisis. Since the late 1990s, overdose fatalities have grown exponentially. In recent years, deaths from synthetic opioids such as fentanyl have skyrocketed, leaving lawmakers and treatment providers across the ­country scrambling for solutions.

What are the historical statistics on overdose fatalities in the U.S.? Between 1999 and 2019, overdose deaths climbed from 16,849 to 70,630, according to the Centers for Disease Control and Prevention. The pandemic accelerated the trend: In 2020, 30 percent more Americans—91,799—died by overdose. In 2021, the death toll jumped another 16 percent to 106,000.

What are the latest numbers? Preliminary estimates indicate deaths declined slightly during the first nine months of last year, but they still remained about 50 ­percent higher than pre-pandemic numbers.

What is fentanyl’s role? Powerful synthetic opioids like fentanyl caused two-thirds of overdose deaths in 2021. Fentanyl can be deadly at a 2-milligram dose and is about 100 times stronger than morphine. Narcotics users risk unintentionally consuming the drug because dealers often mix it with others such as ­heroin, methamphetamine, and cocaine.

What about xylazine? This tranquilizer is infiltrating the fentanyl supply and puts users at even greater risk of fatal overdoses. Known on the street as “tranq” or “tranq dope,” the drug is not an opioid and is resistant to the overdose-reversing medication Narcan. The Drug Enforcement Administration has seized mixtures containing both fentanyl and xylazine in 48 states.

Where are these drugs coming from? DEA officials say the Sinaloa and Jalisco cartels produce most U.S. fentanyl in Mexican labs using precursor chemicals from China. Cartels primarily smuggle the drug through ports of entry at the Southwest ­border. In 2021, xylazine was found in 90 percent of drug samples in Philadelphia and rapidly spread west across the United States.

How are lawmakers addressing the problem? Harm reduction strategies—measures that make taking illicit drugs less risky—have gained popularity in recent years. Lawmakers in several states have legalized user test strips that detect the presence of fentanyl in illegal drugs. Some jurisdictions have outfitted schools and other public areas with Narcan. Some states have also experimented with safe consumption sites. Critics argue harm reduction approaches make illicit drugs more socially acceptable and are unlikely to get people into rehab—or free them from deadly addictions.