Missouri's Fentanyl Problem: The China Connection

Area of Science:

• Public Health
• Epidemiology
• Toxicology

Background:

• Missouri experienced a significant increase in opioid overdose deaths in 2018, contrasting with national trends.
• This rise was particularly pronounced, marking the largest absolute and percentage increase nationwide.
• Illicitly manufactured fentanyl (IMF) emerged as a primary driver of this escalating crisis.

Purpose of the Study:

• To identify the primary substances contributing to the rise in opioid overdose deaths in Missouri.
• To pinpoint geographical areas within Missouri experiencing the highest rates of opioid fatalities.
• To investigate the origins and supply chain dynamics of illicit synthetic opioids impacting Missouri.

Main Methods:

• Analysis of CDC Wonder data and reports from county medical examiners.
• Review of information from law enforcement and drug addiction prevention agencies.
• Examination of preliminary 2020 data from medical examiners' offices.

Main Results:

• Illicitly manufactured fentanyl (IMF) and its analogues were identified as the main cause of increased opioid deaths in Missouri.
• Stimulant overdoses, primarily from methamphetamine, were the second leading cause.
• Opioid deaths were highest in St. Louis and its surrounding fringe areas.

Conclusions:

• IMF and related synthetic opioids originating from China are the principal cause of fatal overdoses in Missouri.
• Despite initial COVID-19 disruptions, Chinese fentanyl production and distribution networks have seemingly recovered.
• Preliminary 2020 data suggest a resurgence in opioid deaths, underscoring the persistent threat of restored supply chains.