Figure 2. National Drug Overdose Deaths—Number Among All Ages, 1999-2017. Among the more than 70,200 drug overdose deaths estimated in 2017, the sharpest increase by a wide margin occurred among deaths related to fentanyl and fentanyl analogs (other synthetic narcotics) with more than 28,400 overdose deaths. Source: CDC WONDER

Figure 3. National Overdose Deaths Involving Any Opioid—Number Among All Ages, by Gender, 1999-2017. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving opioids from 1999 to 2017. Any opioids includes prescription opioids (and methadone), heroin and other synthetic narcotics (mainly fentanyl). Drug overdose deaths rose from 8,048 in 1999 to 47,600 in 2017......a 6 times higher number!  The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2017. Overall, there has been a higher number of drug overdose deaths among males. (Source: CDC WONDER).

Figure 4. National Overdose Deaths Involving Prescription Opioids—Number Among All Ages, 1999-2017. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving prescriptions opioids (including methadone) from 1999 to 2017. Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. Since 2011, however, the number of deaths have only increased slightly, with government laws for obtaining  prescription opioids becoming much stricter. The number of deaths involving prescription opioids in combination with synthetic narcotics has been increasing steadily since 2014 and shows that the increase in deaths involving prescription opioids is driven by the use of fentanyl(Source: CDC WONDER).

Edit: I was looking at this again and realized that deaths from prescription opioids by themselves have gone down since 2011. DOWN!!!

Figure 5. National Overdose Deaths Involving Heroin—Number Among All Ages, 1999-2017.  Drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,482 in 2017 .......this is 7 times the number in 18 years! The bars are overlaid by lines showing the number of deaths involving heroin in combination with other synthetic narcotics (mainly fentanyl) and without other synthetic narcotics from 1999 to 2017. The number of deaths involving heroin in combination with synthetic narcotics has been increasing steadily since 2014 and shows that the increase in deaths involving heroin is driven by the use of fentanyl (Source: CDC WONDER).

Figure 6. National Drug Overdose Deaths Involving Psychostimulants With Abuse Potential (Including Methamphetamine), by Opioid Involvement, Number Among All Ages, 1999-2017. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving psychostimulants from 1999 to 2017. Drug overdose deaths rose from 547 in 1999 to 10,333 in 2017.....a huge increase.  The bars are overlaid by lines showing the number of deaths involving psychostimulants and any opioid, psychostimulants without any opioid, and psychostimulants and other synthetic narcotics. The number of deaths involving the combination of psychostimulants with any opioid has been increasing steadily since 2014 and is mainly driven by the involvement of other synthetic narcotics; however, deaths involving psychostimulants without the involvement of any opioid are also on the rise (Source: CDC WONDER).

Figure 7. National Drug Overdose Deaths Involving Cocaine, by Opioid Involvement–Number Among All Ages, 1999-2017.  Drug overdose deaths involving cocaine rose from 3,822 in 1999 to 13,942 in 2017. The bars are overlaid by lines showing the number of deaths involving cocaine and any opioid, cocaine without any opioid, and cocaine and other synthetic narcotics. The number of deaths in combination with any opioid has been increasing steadily since 2014 and is mainly driven by deaths involving cocaine in combination with other synthetic narcotics mainly fentanyl.  (Source: CDC WONDER).

Figure 8. National Drug Overdose Deaths Involving Benzodiazepines, by Opioid Involvement–Number Among All Ages, 1999-2017.  Drug overdose deaths involving benzodiazepines rose from 1,135 in 1999 to 11,537 in 2017. The bars are overlaid by lines showing the number of deaths involving benzodiazepines and any opioid, benzodiazepines without any opioid, and benzodiazepines and other synthetic narcotics. The number of deaths involving benzodiazepines in combination with other synthetic narcotics, mainly fentanyl has been increasing steadily since 2014 while deaths involving benzodiazepines without any opioids has remained steady (Source: CDC WONDER).

Figure 9. National Drug Overdose Deaths Involving Antidepressants, by Opioid Involvement–Number Among All Ages, 1999-2017. Drug overdose deaths involving antidepressants rose from 1,749 in 1999 to 5,269 in 2017. The bars are overlaid by lines showing the number of deaths involving antidepressants and any opioid, antidepressants without any opioid, and antidepressants and other synthetic narcotics. The number of deaths involving antidepressants in combination with other synthetic narcotics has been increasing steadily since 2014 while deaths involving antidepressants without any opioids has remained steady (Source: CDC WONDER).

Where is the fentanyl coming from?

Drug trade war: Chinese fentanyl is fueling the US opioid crisis

https://wjla.com/news/nation-world/chinese-fentanyl-is-fueling-the-us-opioid-crisis-drug-trade-tensions-escalate

China leads the world in the production and supply of fentanyl and the chemical precursors used to manufacture the drug. Roughly 68 percent of all global fentanyl movements originate in China, according to the Defense Intelligence Agency. 17% comes from Mexico.

"A single individual with a computer, P.O. Box, and a pill press can order fentanyl directly from China to his or her home," Grassley said, describing the rise of a mom and pop shop model of drug trafficking. "For the cost of a few thousand dollars of raw product, the sole proprietor can turn that raw fentanyl into thousands of pills worth literally millions of dollars on the street."

"The Drug Enforcement Agencyhas estimated a kilogram of fentanyl priced at roughly $5,000 can yield $1.5 million in profits when pressed into counterfeit pills, cut into heroin or sold on the street."

Fentanyl has taken over America's drug market. Where is it coming from?

https://www.sandiegouniontribune.com/news/public-safety/sd-me-fentanyl-pipeline-20180617-story.html

"Flowing in one direction, this fentanyl pipeline runs through Mexican cartel strongholds and heads north on well-established drug trafficking routes. It funnels 80 percent of the drug through the San Diego border before dispersing throughout the U.S.

The pipeline flows in another direction, as well, direct from Chinese laboratories to U.S. customers through the mail, bringing small, hard-to-detect packages of extremely pure fentanyl to suburban doorsteps.

Both channels are feeding a deadly epidemic, moving a drug so potent that the equivalent of a few grains of table salt can be fatal."

Poorly blended batches can create fentanyl hotspots, proving fatal for unsuspecting users. While some traffickers brag about using top-of-the-line mixers — sometimes the same machinery used by pharmaceutical companies — others use rudimentary equipment, authorities say.

Why take the risk of killing off customers? It all comes down to economics. Fentanyl can be cheaply procured from Chinese laboratories, and a little bit goes a long way.

Consider what it takes to produce heroin — large plots of secure land to grow opium poppies, a labor force for farming and refining, and several months of time. Then you’ve got weather, pests and water supply issues to deal with.

Move the entire process to a lab and it is so much more predictable — and profitable.

With fentanyl, you need about 20 times less product to achieve the same high as heroin.

One kilogram of pure fentanyl from China, costing about $3,300 to $5,000, can be turned into a diluted powder sold on San Diego streets at a $300,000 value, according to the DEA. As it travels farther away from the border, the value skyrockets.

The border's deadliest threat: opioids

https://www.axios.com/the-borders-deadliest-threat-opioids-1546890347-a3b617cd-5de1-41df-8e4e-ccb598ebd0eb.html

The big picture: Most heroin seized in the U.S. comes from Mexico, according to a 2018 Drug Enforcement Administration report. 

• While fentanyl exported from China is more pure than Mexican fentanyl, the U.S. seizes higher quantities of Mexican fentanyl. There's also evidence that Mexican traffickers order fentanyl from China and smuggle it into the U.S. themselves.
• Some opioids – especially fentanyl from China – come into the U.S. through the international mail system, but most drug smuggling attempts occur at and between southwest entry points.

From Time magazine: January 31, 2019: U.S. Border Patrol Reports Largest Fentanyl Bust of Nearly 254 Pounds of Opioid

http://time.com/5517842/largest-opioid-fentanyl-bust-border-patrol/

"(PHOENIX) — U.S. Customs and Border Protection officials announced Thursday their biggest fentanyl bust ever, saying they captured nearly 254 pounds (114 kilograms) of the synthetic drug that is helping fueling a national epidemic of fatal opioid overdoses from a secret compartment inside a load of Mexican produce heading into Arizona.

DEA officials have said that while 85 percent of the illicit fentanyl entering the United States from Mexico is seized at San Diego-area border crossings, an increasing amount is being detected on the border with Arizona, a state where the Sinaloa cartel controls the drug trade and fatal fentanyl overdoses are rising.

The federal Centers for Disease Control and Prevention says in a recent report that fentanyl is now the drug most often involved in fatal overdoses across the country, accounting for more than 18,000, or almost 29 percent, of the 63,000 overdose fatalities in 2016."