Once a problem confined to the eastern part of the country, fentanyl has spread west

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LAST YEAR was a woeful time for people suffering from a drug addiction. Government shutdowns brought job losses and social isolation—conditions that make a transportive high all the more enticing. Those who had previously used drugs with others did so alone; if they overdosed, no one was around to call for help or administer naloxone, a medication that reverses opioid overdoses.

Fatal overdoses were marching upwards before the pandemic. But they leapt in the first part of last year as states locked down, according to provisional data from the Centres for Disease Control and Prevention. Deaths from synthetic opioids—the biggest killer—were up by 52% year-on-year in the 12 months to August, the last month for which data are available. Those drugs killed nearly 52,000 Americans during the period; cocaine and heroin killed about 16,000 and 14,000, respectively (see chart). Once fatalities are fully tallied for 2020, in a few months’ time, it is likely to be the deadliest year yet in America’s opioid epidemic.

The scourge is worsening in the western part of the country. Deaths from synthetic opioids such as fentanyl rose by 110% year-on-year in the 12 months to August in 16 states west of the Mississippi River. Fentanyl first appeared in Appalachia and New England. It mixes easily with the white-powder heroin consumed there but not with the gummy black tar variety more commonly found in the west. Its westward migration was not inevitable. Markets can vary even across short distances: fentanyl dominates the illicit opioid market in Estonia, for example, but not that in Finland, only a ferry ride away.

The toll from fentanyl shows no sign of slowing. The drug’s potency makes it easy to misjudge dosage, especially for new users without a tolerance. Increasingly, counterfeit prescription pills, resembling oxycodone tablets or benzodiazepines such as Xanax, contain fentanyl. Brad Finegood, an adviser to the public-health department for Seattle and King County, says he has seen lots of unsuspecting people casually take a fentanyl-laced pill and die. Deaths from fentanyl in King County, which includes Seattle, rose from three in 2015 to 176 last year. Mr Finegood’s office has launched a campaign warning people not to be “faked out” by knock-off pills.

Thanks to the pandemic, addicts have better access to treatment through telemedicine. Some states allowed doctors to prescribe methadone, an artificial opiate used to treat heroin addiction, to be taken at home, saving patients trips to the clinic. Such innovations will probably outlast covid-19. Lawmakers want the Biden administration to ease prescription rules around buprenorphine, another opioid substitute, by waiving a requirement that doctors undergo special training to prescribe it.

Though it commands less attention now because of covid-19, America’s opioid epidemic is getting worse. “Picking up the pieces of the crisis is going to be a heavier lift now”, says Bryce Pardo, a researcher at the RAND Corporation, a think-tank. The country will have to reckon with a deadlier drug supply in future.