The Rapidly Changing US Illicit Drug Market and the Potential for an Improved Early Warning System: Evidence from Ohio Drug Crime Labs

Drug Alcohol Depend. 2020 Mar 1:208:107779. doi: 10.1016/j.drugalcdep.2019.107779. Epub 2020 Jan 7.


Background: The US has seen a rapid increase in synthetic opioid-related overdose deaths. We investigate Ohio, a state with one of the highest overdose death rates in 2017 and substantial numbers of deaths related to fentanyl, carfentanil, and other fentanyl analogs, to provide detailed evidence about the relationship between changes in the illicit drug market and overdose deaths.

Methods: We investigate the illicit drug market using Ohio's Bureau of Criminal Investigation's (BCI) crime lab data from 2009 to 2018 that shows the content of drugs seized by law enforcement. We use Poisson regression analysis to estimate the relationship between monthly crime lab data and monthly unintentional drug overdose death data at the county level.

Results: During this time period there has been a rapid change in the composition of drugs analyzed by the BCI labs, with a rapid fall in heroin observations, simultaneous rise in synthetic opioids, and an increase in the number of different fentanyl analogs. We find that the increased presence of fentanyl, carfentanil, and other fentanyl analogs have a strong correlation with an increase in overdose deaths. The types of opioids most associated with deaths varies by the population size of the county.

Conclusions: Crime lab data has the potential to be used as an early warning system to alert persons who inject drugs, harm reduction services, first responders, and law enforcement about changes in the illicit opioid risk environment.

Keywords: Carfentanil; Fentanyl; Fentanyl Analogs; Ohio; Overdose Deaths.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Crime / legislation & jurisprudence*
  • Crime / trends*
  • Drug Overdose / mortality
  • Female
  • Fentanyl / adverse effects
  • Fentanyl / analogs & derivatives
  • Forensic Medicine / methods
  • Forensic Medicine / trends
  • Heroin / adverse effects
  • Humans
  • Illicit Drugs / adverse effects
  • Illicit Drugs / legislation & jurisprudence*
  • Law Enforcement / methods*
  • Male
  • Ohio / epidemiology
  • Opiate Overdose / epidemiology*
  • Opiate Overdose / prevention & control


  • Analgesics, Opioid
  • Illicit Drugs
  • Heroin
  • carfentanil
  • Fentanyl