Key findings
Data from the National Vital Statistics System
The age-adjusted rate of drug overdose deaths increased from 8.9 deaths per 100,000 standard population in 2003 to 32.6 in 2022; however, the rate decreased to 31.3 in 2023. Rates decreased between 2022 and 2023 for people ages 15–54 and increased for adults age 55 and older. From 2022 to 2023, rates decreased for White non-Hispanic people, while rates for other race and Hispanic-origin groups generally stayed the same or increased. Between 2022 and 2023, rates declined for deaths involving synthetic opioids other than methadone, heroin, and natural and semisynthetic opioids, while the rate for methadone remained the same. From 2022 to 2023, rates increased for deaths involving cocaine by 4.9% (from 8.2 to 8.6) and psychostimulants with abuse potential by 1.9% (10.4 to 10.6).
my understanding is that the illicit production and distribution of fentanyl was refined around this time. just prior to this, a large number of people were introduced to opioids via prescriptions. this was due to lack of regulation/enforcement in the US pharmaceutical/medical industries. people were taking a lot of opioids that were prescribed to them, and also they were selling all/some of their prescribed meds to others. when this started to cause issues in communities, the reaction from Medicine was to swing the pendulum very quickly in the other direction and completely change their practice. there was a thing called "deprescribing" where doctors would just inform their patients they were to be cut off their meds, with very short notice. it was an intervention designed to decrease the overall supply of drugs available in the communities. as you may know, stopping opioids suddenly, no matter where you got them or why you are taking them, is extremely unpleasant. so the patients themselves, or the people who were buying their meds, needed to find an alternate source. the fent supply chain was there for them.
fentanyl as a pharmaceutical has been around for decades. in terms of illicit production, it is really a smart business choice due to its potency. when you are smuggling stuff in, volume matters. a very physically small package of fent is worth the same amount of money as a much much larger package of heroin. furthermore, heroin is derived from poppies, which must be farmed in fields and harvested by humans. someone else can give some info w r t afghanistan etc.
so the under regulation of licitly produced pharmaceuticals and and the over regulation (criminalization) of illicitly produced drugs were 2 of the contributing factors. there is also the concept of "deaths of despair".