Responding to the Opioid Crisis

THE EUPHORIC, pain-blocking pro-perties of opioids — a class of drugs made from, or made to mimic, compounds found in opium poppy plants — offer the promise of effective pain relief. At their best, they ease pain; at their worst, they ruin lives. 

Opioids are extremely addictive, and it’s easy to take too much. Since the late 1990s, some one million people have died due to opioid overdose on American soil, and the number continues to grow.¹ According to a Dec. 16, 2024, U.S. Drug Enforcement Agency (DEA) press release, 69 percent of the more than 107,440 drug-related deaths in 2023 involved fentanyl. DEA estimates more than 200 American lives are lost everyday to fentanyl overdose.² 

But numbers aren’t overdosing on opioids: People are. Many of them are routine users of stimulants such as cocaine and methamphetamine who accidentally overdose due to fentanyl that has been added to the drugs to amplify their effects. Others struggle with opioid use disorder (OUD); they are often people with chronic pain who have developed a dependence on their prescription opioid medications and accidentally take more than their body can handle. Still others are people who misuse opioids by taking pills prescribed to someone else. Increasingly, young people are dying after taking just one pill, typically a counterfeit version of a prescription pill such as Percocet or Xanax that was laced with fatal amounts of fentanyl. Even toddlers have become victims by inadvertently ingesting fentanyl. 

Americans from every walk of life are falling prey to lethal doses of these dangerous narcotics. “All Americans across the U.S., coast to coast, and every community in between have been harmed by fentanyl,” said DEA Administrator Anne Milgram in a statement on National Fentanyl Awareness Day in 2024.³ They are our coworkers, neighbors, family and friends — people we know and love. In fact, a recent study published in JAMA Health Forum showed more than a third of the U.S. population knows someone who died of a drug overdose. And while the study did not specify the overdose resulted from opioids, we know opioids have been involved in most drug overdoses for the past 20 years.¹

The opioid epidemic is a complicated crisis, one without an easy off ramp, but a multifaceted, coordinated response effort is underway. Government agencies, nonprofit groups and innovative business solutions are joining forces with an all-hands-on-deck attitude to confront the crisis, support recovery and ultimately save lives. 

Understanding the Problem

The good news: Deaths involving opioid overdose are down. In May 2025, a Centers for Disease Control and Prevention (CDC) news release reported provisional data from CDC’s National Center for Health Statistics that indicated deaths involving opioids decreased in 2024, dropping from an estimated 83,140 deaths in 2023 to 54,743 deaths in 2024.⁴ 

The bad news: Deaths involving opioid overdose remain critically high. According to DEA, illicit fentanyl is driving the disaster. Small doses of this highly potent, powerful opioid are fatal, and the market is monstrously flooded with it. In 2024, DEA seized more than 60 million fentanyl-laced fake pills containing nearly 8,000 pounds of fentanyl powder, representing more than 196 million deadly doses,⁵ but there is no accounting for how much more was successfully trafficked into the U.S.

Fentanyl is an FDA-approved synthetic opioid used for pain relief that is 100 times more potent than morphine and 50 times more potent than heroin.⁶ When used appropriately and under the supervision of a licensed medical professional, fentanyl has a legitimate medical use. However, illicit fentanyl — fentanyl manufactured outside of the U.S. and then smuggled across the border and sold illegally on American soil — poses a critical risk to the health and safety of its users.

According to DEA’s National Drug Threat Assessment of 2024, the Sinaloa and Jalisco drug cartels are at the heart of the crisis. Their global supply chain networks rely on countries such as China to supply precursor chemicals and pill presses the cartels then use to make counterfeit versions of legitimate pills such as OxyContin, Percocet and Xanax.⁷ Cartels smuggle the drugs into the U.S. and sell them to unsuspecting people, some wishing to circumvent opioid medication limits, some who want to buy prescriptions at a lower price — and none who suspect what they are buying contains enough fentanyl to kill them. These fake pills are sold on bogus online pharmacies or via a social media black market without a prescription and at lower prices.⁷ The situation is exceedingly dangerous: DEA laboratory testing revealed six out of 10 fentanyl-laced fake prescription pills tested in 2022 contain a potentially lethal dose of fentanyl.⁸ Cartels also mix deadly amounts of fentanyl into stimulants such as cocaine and methamphetamine to amplify their effects, and then sell them to recreational drug users who are also dying from opioid overdose. The problem is much larger than counterfeit pills. 

According to Scott Fishman, MD, director of the University of California, Davis, Center for Advancing Pain Relief, the opioid crisis didn’t emerge overnight; it started nearly 30 years ago, after legal opioids became routinely prescribed when another American health crisis — chronic pain — emerged in the mid-1990s. In 2001, a Joint Commission program set pain as the fifth vital sign; in addition to assessing body temperature, blood pressure, pulse and respiratory rate, clinicians began asking patients to rate their pain on a numeric scale, with one being mild pain and 10 being the worst pain possible.⁹ 

Clinicians were trained to prescribe pain medication because they were not equipped to understand it or treat it appropriately. “Without this knowledge, and confronted with limited time, as well as mounting pressure for patient satisfaction, limited insurance coverage for non-opioid options, inaccurate data on opioid safety, and influences from drug companies, many clinicians reached for the easiest available treatment: opioids,” wrote Scott Fishman, MD, in a 2021 article in Pain Medicine.9 Pain wasn’t treated; it was relieved. Between 2006 and 2012, 76 billion oxycodone and hydrocodone pills were dispersed, largely prescribed at high doses for long durations — a practice we now know is high-risk and associated with opioid abuse.¹⁰ 

The effort was well-intentioned but counterproductive: Addressing pain with opioids ignited a firestorm of addiction to them — what CDC describes as the first wave of the opioid crisis. Opioid use disorder (OUD) became prevalent among patients prescribed legal opioid medicines; the powerful painkillers are highly addictive, and even the most controlled use of them often hooks patients and puts them at risk for accidental overdose.

Laws to limit the dosage and duration of opioids physicians could prescribe were passed in 2016; the hope was that restrictions would ameliorate misuse and addiction, and ultimately save lives. The opposite happened. Dependence raged, so patients looked for narcotics elsewhere. Many turned to heroin, an illegal opioid drug made from morphine. We know what happened next: a second wave of the opioid crisis marked by more misuse, addiction and overdose. Once illicit synthetic fentanyl flooded the market, the third wave began and people began unintentionally ingesting lethal amounts of fentanyl they didn’t know were there.¹¹ 

Fentanyl Poisoning

Whereas opioid overdoses typically occur when people knowingly ingest opioids but inadvertently take too much
(as in patients who take prescription opioids to control pain), fentanyl poisoning occurs when someone accidentally ingests a lethal amount of fentanyl, usually when they take a counterfeit pill laced with lethal amounts of the powerful narcotic. Even very small amounts of fentanyl — just two milligrams — can kill. According to DEA, fentanyl is the deadliest drug threat facing the U.S.⁸

And it’s no wonder: Fentanyl is showing up in places people do not expect to find it. 

But counterfeit versions of legal prescription medications are increasingly easy to get via the dark web and social media, where pills are inexpensive and unregulated. People suffering from chronic pain or OUD use these online outlets for easy access to legal medications such as Vicodin, OxyContin and Percocet, and many high school and college students seek out “study drugs,” stimulants such as Adderall or Ritalin, believing they will help improve academic performance,¹² or benzodiazepines such as Xanax or Valium, thinking they will help them deal with anxiety.¹³ 

Pills obtained through illegitimate sources are often counterfeit and usually contain fentanyl. The fake pills might contain the same active ingredient as the real thing, but they might not; and if they do, it may be in different quantities. There is no quality control and no guarantee the drugs are safe. In fact, while fentanyl can be detected in them, there is no way to determine whether it is a lethal amount.¹⁴ All it takes is one pill containing too much fentanyl to kill. 

According to Get Smart About Drugs, a DEA resource for parents, educators and caregivers, fentanyl overdose is the leading cause of death for Americans age 18 to 45.¹⁵ And, according to a 2024 UCLA Health article, an average of 22 adolescents ages 14 to 18 died each week in 2022 from drug overdoses.¹⁶ 

Even younger children are at risk of fentanyl poisoning when drug paraphernalia or everyday objects contaminated with opioids are within reach. 

A 2-year-old boy in Grass Valley, Calif., who got his hands on drug paraphernalia in his own home was hospitalized for a suspected fentanyl overdose. According to a Nevada County Sheriff’s office (NCSO) media release, emergency services received a distraught phone call on Dec. 10, 2024, reporting the toddler was overdosing on fentanyl. Emergency personnel found the child unresponsive and not breathing; they gave him multiple doses of naloxone, which revived him. Notably, NCSO officials found narcotics and drug paraphernalia in plain view at the toddler’s home, some of which appeared to be fentanyl and methamphetamine along with pipes and syringes. “It should be noted many of these items could be easily accessed by a child and some were found on the floor,” an agency spokesman said.¹⁷

A 1-year-old boy died on May 22, 2024, after ingesting a lethal amount of fentanyl. He was found unresponsive at Melville J. Courson Park and tragically never woke up.¹⁸ Yet another 1-year-old child suffered a fentanyl poisoning at a park in New Britain, Conn., on July 14, 2024. The boy had picked up a piece of plastic contaminated with opioids; he was revived and lived. Assistant Child Advocate Brendan Burke issued a stark warning: This could happen to any child, any time. “It could be any park, any public space, it could be anywhere because people are using drugs everywhere,” Burke said. “Any time a child has access to that kind of paraphernalia and puts it in their mouth, it’s a life-threatening event.”¹⁹

Action and Awareness

Addressing the opioid crisis remains a work in progress. The problem is too big for any one agency to tackle on its own, but federal and state government agencies, public health associations and community-based organizations are taking action to protect the American people, prosecute drug dealers and provide rescue and recovery support. With so many initiatives at the federal and state level, as well as in the private sector, it is impossible to list them all here. However, the response comes down to five major goals:

• Stop the flow of fentanyl. One aim is to cut fentanyl off at the source and prevent it from entering the nation. It’s a big job, but U.S. Customs and Border Protection (CBP), an agency of the Department of Homeland Security, intercepts and seizes illegal drugs at the border every day. For example, CBP officers at the San Ysidro Port of Entry discovered and seized more than 25 pounds of fentanyl powder and nearly 60 pounds of cocaine when they searched the truck of a 59-year-old man seeking entry to the U.S. from Mexico on Nov. 19, 2024. “San Ysidro officers continue to exhibit unparalleled vigilance and expertise in successfully detecting narcotics that were meticulously concealed in non-factory metal compartments within the vehicle,” said Mariza Marin, port director of the San Ysidro Port of Entry. “This incident showcases our dedication to protect our nation and communities from dangerous drugs and organizations intending to cause harm.”²⁰
• Disrupt criminal drug networks and bring dealers to justice. DEA, an agency of the U.S. Department of Justice, targets global criminal networks responsible for the flow of fentanyl into the U.S., with the ultimate objective of destroying the entire criminal enterprise.²¹ DEA works with law enforcement at home and abroad to track down drug distributors and bring them to justice. “It’s in everyone’s best interest to make sure we not only cut off the source, but also arrest as many as we can up the supply chain leadership,” said Assistant Special Agent in Charge Colin Dickey, lead of DEA enforcement operations in eastern Missouri.²¹Lengthy, in-depth investigations into overdose deaths involving fentanyl link distributors to victims. Current federal drug statutes stipulate a 20-year mandatory minimum if death or serious bodily injury results from the use of the drugs, but there is an increasing push for harsher sentences.²² “These are not overdoses. These are murders,” Orange County District Attorney Todd Spitzer emphasized. “These dealers are essentially handing a loaded gun to unsuspecting victims knowing that they will probably die, and they don’t care.”²³The Felony Murder for Deadly Fentanyl Distribution Act of 2023 was introduced to Congress on Feb. 9, 2023; it would make the distribution of fentanyl resulting in death a first-degree murder.²⁴ As of this writing, the bill has been referred to the Committee on the Judiciary, but has not been passed. However, the HALT Fentanyl Act was signed into law by President Donald J. Trump on July 16, 2025. The bill permanently classifies fentanyl-related substances as Schedule I drugs under the Controlled Substances Act; schedule I drugs are substances with a high potential for abuse and indicates potential risks and harm associated with their use. According to President Trump, the legislation is “delivering another defeat for the savage drug smugglers and criminals and the cartels.”²⁵
• Raising public awareness. DEA issues ongoing public safety alerts warning Americans that counterfeit drugs are not safe or smart. It also launched the One Pill Can Kill campaign, which speaks out about the dangers of purchasing pills on social media and the deceptive marketing practices of drug cartels that pass off counterfeit pills as legitimate prescriptions.²⁶ The campaign provides social media graphics, images, sample posts, hashtags such as #onepillcankill and informative resources to educate parents and kids.At the state level, governors have taken emergency action to combat the crisis and created similar campaigns to inform citizens about the dangers of fentanyl, and the first spouses have been instrumental in raising awareness. Led by Virginia First Lady Suzanne Youngkin and New Jersey First Lady Tammy Murphy, the first spouses have worked with the National Governors Association to arrange a briefing for state governors’ staff members and the first spouses to hear from some of the nation’s leading experts about national campaigns addressing the opioid epidemic, including the Ad Council, a non-profit organization that launched the Youth Fentanyl Awareness campaign. The first spouses were instrumental in establishing Aug. 21 as National Fentanyl Prevention and Awareness Day and Aug. 31 as International Overdose Awareness Day. “We hope to ensure that every family has the resources and information needed to protect their children from this deadly threat,” said Youngkin.²⁷
• Improving OUD resources and support. The Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the U.S. Department of Health and Human Services (HHS), provides resources and practical support for people struggling with opioid addiction and OUD. SAMHSA awarded $8.1 billion in State Opioid Response grants and $307.5 million in Tribal Opioid Response grants to help fund state and tribal prevention, harm reduction, treatment and recovery support services for OUD and other concurrent substance use disorders.²⁸ SAMHSA also runs the National Helpline (1-800-662-HELP) and launched FindTreatment.gov, a confidential and anonymous resource that helps people seeking treatment for substance use disorders find health facilities, healthcare centers, practitioners who prescribe buprenorphine (a medication often prescribed to those in OUD recovery) and opioid treatment providers, along with information about payment assistance.
• Increasing access to naloxone. Naloxone (generic for Narcan) is a medicine approved by FDA that quickly reverses an opioid overdose. Getting it into the hands of those who are at the highest risk of opioid overdose remains a challenge due to cost and stigma. In 2023, FDA approved the first over-the-counter (OTC) naloxone nasal spray,²⁹ OTC Narcan Nasal Spray, which is now available at pharmacies nationwide for less than $50.²⁸ Some naloxone products still require a prescription. FDA continues to recommend anyone taking opioid medication, knows someone taking opioid medication, taking medications to treat OUD, people who are at higher risk of opioid overdose due to recreational drug use or use of benzodiazepines and caregivers of people at risk for opioid overdose to carry naloxone. “We want naloxone in the hands of friends, family members and caregivers of people taking opioids,” said Marta Sokolowska, PhD, FDA deputy center director for substance use and behavioral health.³⁰ To help reach that goal, most states have “standing orders” that allows other formulations of naloxone to be obtained without a prescription directly from pharmacists. Non-profit groups such as Harbor Path and NEXT Distro are also working to provide naloxone to high-risk individuals for free.Naloxone is accessible — but getting people to use it remains a hurdle. Overdose education and naloxone distribution (OEND) programs help: They train people on how to recognize an overdose, administer naloxone and make naloxone available in communities. But OEND programs target bystanders, not people who use opioids, and programs vary from state to state.

A Rapid Response Is Essential

Despite all the efforts to warn the public about the dangers of fentanyl and cut fentanyl off at the source, opioid overdose and fentanyl poisoning still happens, and fast intervention is necessary to save lives. 

Opioids affect the part of the brain that regulates breathing; during an overdose event, breathing slows and can even stop. Naloxone is the best shot for survival when someone overdoses. This lifesaving medicine is an opioid antagonist: It attaches to opioid receptors, reverses and blocks the effect of opioids and quickly restores regular breathing.³¹ Effects last 30 to 40 minutes, so multiple doses may be necessary. 

Co-prescribing naloxone with prescription opioid medications remains an ongoing strategy to preemptively place naloxone where it may be needed before it is needed. Many stakeholders support co-prescribing naloxone, including CDC and SAMHSA, state departments of health, the World Health Organization and many advocacy groups such as the American Medical Association (AMA). “If it were not for naloxone, it is likely that many thousands more would be dead from an opioid-related overdose,” said Patrice A. Harris, MD, chair of the AMA Opioid Task Force. “We know that naloxone — by itself — will not reverse the nation’s opioid epidemic, but it is a critical component that saves lives and provides a second chance.”³² The AMA Opioid Task Force encourages physicians to co-prescribe naloxone when clinically appropriate and advises them to consider whether the patient has a history of taking high doses of opioids or a concomitant benzodiazepine; has a history of substance use disorder; has an underlying mental health condition; has a medical condition such as respiratory disease that may make him or her more susceptible to opioid overdose; or is in a position to help someone else at risk for an opioid overdose.³³

According to CDC, someone else was nearby in more than 40 percent of overdose deaths: “Having naloxone available allows bystanders to help a fatal overdose and save lives.”³⁴ A study published in Drug and Alcohol Dependence Reports also showed that when naloxone is put in the hands of the community, they will use it. Expanding access and availability of naloxone in communities is among the most impactful interventions in decreasing opioid overdose deaths, but state distribution rates of naloxone do not meet community need.³⁴ A 2021 modeling study that set a saturation benchmark of naloxone available at 80 percent of witnessed overdoses found nearly every state in the U.S. was undersaturated with naloxone.³⁵ 

Reduce Stigma, Save Lives

Rooting out the problem is one thing; rescuing victims is another. But regardless of whether fentanyl poisoning was incidental or accidental, the stigma attached to it minimizes the perceived danger. People think, “I’m not an addict,” “It won’t happen to me” or “My kid knows better,” and these assumptions cost lives. Fentanyl is everywhere. The toddlers who overdosed at daycare and on a public playground are proof that addiction isn’t the only reason for the public health fiasco.36 Efforts to crush the criminal drug circuit, raise awareness, bolster OUD recovery resources and increase access to naloxone will certainly help save lives, but until the flow of fentanyl stops, people from all walks of life remain at risk. 

“We’ve got to get over the stigma associated with drug use,” Davis added. “Fentanyl is a game-changer, and we are in a public safety crisis because of it. It impacts all races, genders and people across the socio-economic spectrum. We’ll keep arresting the criminals and reducing the supply of this man-made health hazard, but to reduce the demand, it’s going to take all of us to bring down these overdose deaths.”²¹