the 12-month period ending april 2021, according to provisional data published november 17, 2021, by the us centers for disease control and prevention. overdose deaths increased 28.5% from the same period a year earlier and nearly doubled over the previous five years. opioids continued to be the primary cause of drug overdose deaths. additionally, the drug is increasingly affecting younger populations. a 2018 study found that fentanyl is involved in the majority of opioid-related deaths and that deaths involving fentanyl were more likely to occur in younger age groups and among non-hispanic white individuals. furthermore, young adults are increasingly affected by nonfatal fentanyl overdoses in recent time periods along with these other deadly occurrences. many sources point to fentanyl as the leading cause of teen overdose death. according to a 2022 study in the journal of the american medical association, between 2010 and 2021, the number of teenage deaths caused by black-market fentanyl and related synthetic substances increased more than twentyfold, from 38 to 884. the drug is 50 to 100 times stronger than morphine and often cut with other drugs, meaning the user does not know they are taking fentanyl. the drug enforcement administration (dea) says 2.2 pounds represents half a million lethal doses. synthetic opioids, primarily fentanyl, caused nearly two-thirds (64%) of all drug overdose deaths in the 12-month period ending april 2021, up 49% from the year before, the cdc's 's national center for health statistics found. there have always been drug addicts in need of help, but the scale of the present wave of heroin and opioid abuse is unprecedented. in maryland, the first six months of 2015 saw 121 fentanyl deaths. in the first six months of 2016, the figure rose to 446. christopher caldwell, senior editor the weekly standard fentanyl, a synthetic opioid painkiller, is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin, with only 2 mg becoming a lethal dose. it is pure white, odorless and flavorless. the potency of fentanyl has led to the mistaken belief that exposure to fentanyl by touch can cause an overdose, a myth that has been repeated by media outlets and even government publications. as a result, the drug enforcement administration has recommended that officers not field test drugs if fentanyl is suspected, but instead collect and send samples to a laboratory for analysis. "exposure via inhalation or skin absorption can be deadly," they state. however, the american college of medical toxicity and the american academy of clinical toxicology stated that, as of 2017, they were not aware of "emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids.". a 2021 article in the journal health & justice reported that "many of the reported fentanyl exposure incidents among police share the symptoms of a panic attack rather an opioid overdose," and a 2020 article from the journal of medical toxicology stated that "the consensus of the scientific community remains that illness from unintentional exposures is extremely unlikely, because opioids are not efficiently absorbed through the skin and are unlikely to be carried in the air." according to the united states drug enforcement agency in 2023, china continued to be the primary source of fentanyl being imported into the united states, killing over 100 americans every day. over a two-year period, close to $800 million worth of fentanyl pills were illegally sold online to the us by chinese distributors. the drug is usually manufactured in china, then shipped to mexico, where it is processed and packaged, which is then smuggled into the us by drug cartels. a large amount is also purchased online and shipped through the us postal service. it can also be purchased directly from china, which has become a major manufacturer of various synthetic drugs illegal in the us. ap reporters found multiple sellers in china willing to ship carfentanyl, an elephant tranquilizer that is so potent it has been considered a chemical weapon. the sellers also offered advice on how to evade screening by us authorities. according to assistant us attorney, matt cronin: it is a fact that the people's republic of china is the source for the vast majority of synthetic opioids that are flooding the streets of the united states and western democracies. it is a fact that these synthetic opioids are responsible for the overwhelming increase in overdose deaths in the united states. it is a fact that if the people's republic of china wanted to shut down the synthetic opioids industry, they could do so in a day. annual fentanyl seizures in mexico. deaths from fentanyl in 2016 increased by 540 percent across the united states since 2015. this accounts for almost "all the increase in drug overdose deaths from 2015 to 2016", according to a study published in the journal of the american medical association. readily available fentanyl killed 70,000 people in 2021 alone. fentanyl-laced heroin has become a big problem for major cities, including philadelphia, detroit and chicago. its use has caused a spike in deaths among users of heroin and prescription painkillers, while becoming easier to obtain and conceal. some arrested or hospitalized users are surprised to find that what they thought was heroin was actually fentanyl. according to former cdc director tom frieden: as overdose deaths involving heroin more than quadrupled since 2010, what was a slow stream of illicit fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, is now a flood, with the amount of the powerful drug seized by law enforcement increasing dramatically. america is awash in opioids; urgent action is critical. according to the centers for disease control and prevention (cdc), death rates from synthetic opioids, including fentanyl, increased over 72% from 2014 to 2015. in addition, the cdc reports that the total deaths from opioid overdoses may be under-counted, since they do not include deaths that are associated with synthetic opioids which are used as pain relievers. the cdc presumes that a large proportion of the increase in deaths is due to illegally-made fentanyl; as the statistics on overdose deaths (as of 2015) do not distinguish pharmaceutical fentanyl from illegally-made fentanyl, the actual death rate could, therefore, be much higher than reported. those taking fentanyl-laced heroin are more likely to overdose because they do not know they also are ingesting the more powerful drug. the most high-profile death involving an accidental overdose of fentanyl was singer prince. fentanyl has surpassed heroin as a killer in several locales: in all of 2014 the cdc identified 998 fatal fentanyl overdoses in ohio, which is the same number of deaths recorded in just the first five months of 2015. the us attorney for the northern district of ohio stated:one of the truly terrifying things is the pills are pressed and dyed to look like oxycodone. if you are using oxycodone and take fentanyl not knowing it is fentanyl, that is an overdose waiting to happen. each of those pills is a potential overdose death. in 2016, the medical news site stat reported that while mexican cartels are the main source of heroin smuggled into the us, chinese suppliers provide both raw fentanyl and the machinery necessary for its production. in southern california, a home-operated drug lab with six pill presses was uncovered by federal agents; each machine was capable of producing thousands of pills an hour. overdoses involving fentanyl have greatly contributed to the havoc caused by the opioid epidemic. in new hampshire, two thirds of the fatal drug overdoses involved fentanyl, and most do not know that they are taking fentanyl. in 2017, a cluster of fentanyl overdoses in florida was found to be caused by street sales of fentanyl pills sold as xanax. according to the dea, one kilogram (2.2 lb) of fentanyl can be bought in china for $3,000 to $5,000, and then smuggled into the united states by mail or mexican drug cartels to generate over $1.5 million in revenue. the profitability of this drug has led dealers to adulterate other drugs with fentanyl without the knowledge of the drug user. in 2022, the fda warned, that xylazine, an animal tranquilizer, is increasingly being detected in heroin and illicit fentanyl. one study found that, although relatively uncommon, "the presence of fentanyl in the stimulant supply increased significantly between 2011 and 2016, with the greatest increases occurring between 2015-2016; the presence of these products was concentrated in the u.s. northeast." fentanyl can also be found in opioids prescribed for breakthrough cancer pain in opioid-tolerant patients called transmucosal immediate-release fentanyls (tirfs.) tirfs are subject to a us food and drug administration (fda) risk evaluation and mitigation strategy (rems) to prevent inappropriate prescriptions of these extremely potent drugs. a 2020 study by aventis pharmaceuticals found that higher doses of naloxone, the opioid overdose-reversing medication, can help resuscitate a victim of an overdose involving synthetic opioids such as carfentanil, a substance that is 100 times as strong as fentanyl. according to health crisis alert, "researchers gave monkeys the synthetic opioid carfentanil followed by different doses of naloxone. . . . after receiving naloxone, the monkeys’ brains were observed using positron emission tomography imaging. the higher the level of naloxone, the higher the receptor occupancy." demographics in 2016, opioid overdoses took the lives of approximately 91 americans each day. roughly half of these deaths were caused by prescribed opioids. given the complexity of the topic and the difficulty of controlling factors while researching, there is much speculation the differences between demographics in 2015, anne case and angus deaton's theory of the deaths of despair identified the root causes of the increase in opioid deaths as high levels of poverty, income inequality, and unemployment due to deteriorating labor markets, a lack of access to social capital, a lack of access to healthcare, and high social isolation. they reported that opioid overdose deaths were disproportionately affecting white, middle-aged, and less-educated americans, particularly those living in rural areas. race in the us, addiction and overdoses affect mostly non-hispanic whites from the working class. the prevalence of opioid overdose deaths per 100, 000 within the usa was highest for non-hispanic white, followed by black, hispanic, and asian/pacific islander individuals. during the first and second wave of the opioid epidemic, non-hispanic white and non-hispanic native americans were most affected by opioid overdose. while all groups were affected in the third and fourth wave of the epidemic, non-hispanic native americans and non-hispanic black individuals saw the greatest rise in deaths. native americans and alaska natives experienced a five-fold increase in opioid-overdose deaths between 1999 and 2015, with native americans having the highest increase of any demographic group. with the belief that there would be a low risk of addiction, indian health service physicians, like doctors nationwide, readily prescribed opioids. in addition, structural health care deficiencies from the provider and cultural beliefs against receiving care from the patient, as well as inadequate community support structures for substance misuse, contributed to high mortality rates. in 2015, american indians/alaska natives had the greatest drug overdose mortality rates of any u.s. population, comparable to white americans. in 2018, the opioid crisis continued to disproportionately affect non-hispanic whites and native americans with the national institutes of health (nih) reporting a rise in opioid morbidity and opioid related fatalities. during 2019-2020, non-hispanic american indian/alaska native and non-hispanic black individuals experienced the greatest increases in drug overdose mortality rates. additionally, when accounting for the age-adjusted death rate, non-hispanic american indian/alaska native and non-hispanic black individuals in 2020 and 2021. the percentage of individuals with documentation of prior treatment for substance use disorders was low, especially among black individuals, at 8.3%. overall, hispanic, non-hispanic native hawaiians, and non-hispanic asians experienced the lowest rate of overdose deaths. sex this is especially concerning considering the epidemiology of opioid affliction among white women, who are at a greater risk because they receive more prescription medications than men. according to the nih (2018), "the opioid epidemic is increasingly young, white, and female" with 1.2 million women being diagnosed with an opioid use disorder compared to 0.9 million men in 2015. age in 2014, roughly 12 percent of young adults between the ages of 18 and 25 reported abusing prescribed opioids. non-medical prescription drug use rates have been increasing in teenagers with access to parents' medicine