The epicenter of the opioid epidemic that killed 665,341 people in the United States between 2005 and 2020 shifted geographically from the Northwest to the East, according to a geographical analysis published in The Lancet Regional Health — Americas. Epidemiologists at the University of Cincinnati tracked the epicenter of the epidemic over space and time across the country, driven largely by a shift from prescription opioids to heroin to synthetic substances like fentanyl.
The geographic shift can be narrowed between 2013 and 2016, when lawmakers implemented stricter regulations limiting access to opioids and law enforcement began prosecuting doctors for allegedly prescribing them irresponsibly. In the absence of legal remedies, many people with substance use disorder turned to illicit drugs such as heroin and fentanyl. The populations affected by substance use disorder also changed over the course of the epidemic from homogeneously white populations to populations that now include many Black victims. Between 2013 and 2016, Black communities began having access to synthetic opiates, and those communities have been more affected, particularly by fentanyl.
Understanding the Evolving Crisis
Diego Cuadros, Professor at UC College of Arts and Sciences, emphasized: “The key message is this is an evolving epidemic.” The epidemic is not uniform but represents a series of mini-epidemics identified as hotspots across rural and urban America. Drug overdoses are the leading cause of death for Americans ages 18 to 44, according to the Centers for Disease Control and Prevention.
Santiago Escobar, study lead author and UC graduate, noted: “As the supply and demand dynamic of the substance evolved, so, too, did the vulnerable populations. The type of substances being abused, as well as the means used to access them, were key determinants of which populations suffered a higher mortality.”
Understanding which populations are affected by particular substances can help health officials develop more effective interventions. One proven method has been public distribution of reversal medicines such as naloxone, which is credited with saving tens of thousands of lives in the past 15 years. Experts recommend implementation of early warning systems including the National Drug Early Warning System introduced in 2014, which helps monitor, predict, and respond to the rise of new and emerging psychoactive substances. Another potential intervention is routine testing of illicit substances to determine if they have been adulterated or spiked with life-threatening synthetic opioids.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.uc.edu/news/articles/2025/04/epicenter-of-opioid-epidemic-shifts-with-drug-preferences.html