In 2019/2020, record overdoses from illicit fentanyl tablets or as a deadly adulterant in heroin have ravaged North America. An estimated 19,416 individuals died of a drug overdose in the United States in the first 3 months of 2020 compared with 16,682 in the same 3-month period in 2019; this trend was fueled by synthetic opioids (especially illicitly manufactured fentanyl and analogs). Furthermore, between May 2020 and April 2021, the estimated number of drug overdose deaths in the United States exceeded 100,000 over this time period, with 64.0% of deaths involving synthetic opioids other than methadone (the same illicitly manufactured fentanyls and analogs). In contrast, Europe has seen a decrease from heroin overdoses, and a practical absence of illicit, synthetic opioids.
