The opioid crisis in the United States has evolved from widespread prescription opioid misuse to increased heroin use due to the dangerous rise of illegally manufactured fentanyl (IMF). This study explains long-standing gaps in current national surveys that are criticized for underreporting. The newly gathered data provides a timely and comprehensive assessment of illicit opioid use and initial exposure pathways. The main goals were to determine the paths of early opioid exposure and assess the prevalence of illicit opioid use.
A cross-sectional online survey was conducted on the Respondi platform to 1,515 national adult representatives from June 10 to 17, 2024. Questions regarding recent illicit opioid use, first opioid exposure, and perceived risk of overdose were included in the survey.
IMF use was mentioned by 7.5% of all respondents, with 4.95% indicating purposeful and 2.57% indicating accidental use. The estimated rate of IMF use was 25 times higher than that reported by the 2022 National Survey on Drug Use and Health (NSDUH). Among the 166 respondents who reported recent illegal opioid use, 39.2% started using opioids after receiving a prescription. While 36.1% started using opioids through prescriptions intended for them, and 24.7% started using illegal opioids.
Perceived risk of overdose, there was a wide range in the general population’s perceptions of overdose risk; only 4.7% believed it was “very likely” that they would overdose. That percentage increased to 24.1% among those who take illegal opioids.
The fact that 33.3% of IMF users regarded overdose as “very likely” indicates that the drug’s danger is widely known. According to the study, men were more likely to use illegal opioids (+5.4%) and IMF (+4.4%) than women. Young adults, compared to people over 55 years old, those between the ages of 18 and 34 were 17.4% more likely to use IMF, and 23.7% more likely to use illicit opioids.
With all other parameters remaining constant, we presented the likelihood changes associated with each attribute. Robust standard errors and the delta approach were used to create 95% confidence intervals (CIs). The discrepancy between this study and official statistics highlights flaws in the data collection process, including underreporting, limited survey questions, and reliance on in-person interviews that may discourage candid responses.
This study highlights the importance of strict limits and examination of opioid prescriptions. Near real-time insights were obtained with a quick, online survey method, which also attracted attention to the drawbacks of conventional national surveys and the alternative data collection techniques. It will take more time and detailed data in the future to monitor and address the opioid issue. According to these findings, policy solutions need to be re-evaluated to reflect the scope and complexity of the developing issue.
Reference: Powell D, Jacobson M. Estimates of illicit opioid use in the US. JAMA Health Forum. 2025;6(5):e250809. doi:10.1001/jamahealthforum.2025.0809
