<i>Notes from the Field:</i> Geo-Temporal Trends in Fentanyl Administration Routes Among Adults Reporting Use of Illegally Manufactured Fentanyl When Assessed for Substance-Use Treatment — 14 U.S. States, 2017–2023

During 2019-2023, U.S. overdose deaths involving fentanyl have more than doubled, from an estimated 35,474 in 2019 to 72,219 in 2023 (1).From 2020 to 2022, overdose deaths with only illegally manufactured fentanyl (IMF) detected and evidence of smoking IMF increased by 78.9%; deaths with evidence of injection decreased by 41.6% (2).Smoking, however, could not be linked specifically to IMF use when deaths involved multiple drugs (e.g., methamphetamine co-used with IMF).To characterize IMF administration routes among all persons who use IMF, with or without other drugs, IMF administration routes were examined among adults assessed for substance use treatment who used IMF during the past 30 days. Investigation and OutcomesThe National Addictions Vigilance Intervention and Prevention Program's Addiction Severity Index-Multimedia Version (ASI-MV) tool* includes a convenience sample of adults aged 18 years assessed for substance-use treatment.CDC analyzed treatment assessments conducted between July 1, 2017, and June 30, 2023, which were restricted to 14 states with at least 100 assessments reporting past 30-day IMF use (16,636) and stratified by administration routes (swallowed, snorted or sniffed, smoked, and injected ).The percentage of persons reporting each administration route was calculated for * https://uprisehealth.com/resources/national-addictions-vigilance-interventionand-prevention-program-navipprotm-a-real-time-product-specific-publichealth-surveillance-system-for-monitoring-prescription-drug-abuse/ Selected states with at least 100 assessments reporting past 30-day IMF use during July 2017-June 2023: Northeast: Massachusetts (3,692); Midwest: Michigan (1,026), Missouri (463), Indiana (186), and Ohio (130); South: Tennessee (6,200), Oklahoma (2,201), Maryland (1,248), Florida (250), Louisiana (198), West Virginia (127), and North Carolina (123); and West: Wyoming (409) and Colorado (383). The ASI-MV assessment asks persons completing the questionnaire, "In the past 30 days, estimate how many days you used street fentanyl."The definition of street fentanyl in the ASI-MV was "Street fentanyl (illegal fentanyl and carfentanil, sometimes combined with other drugs such as heroin or cocaine)."In this study, 2.6% of ASI-MV assessments were repeat assessments, indicating that they were completed by a unique person with a previous assessment within the 6-month period. IMF administration routes are not mutually exclusive.A person can report more than one route in the survey, and the sum of proportions can exceed one.The injection category includes injection in the vein and the skin or muscle.