Across Alaska, Dr. Zink said, fentanyl kills many overdose victims before bystanders or emergency responders can revive them with naloxone, a medication that can quickly reverse an opioid overdose.
“You don’t have a second chance if you don’t immediately have naloxone available,” she said.
A recent study of illicit pills seized by drug enforcement authorities found that a substantial share of what is marketed as OxyContin, Xanax or the attention deficit hyperactivity disorder drug Adderall now contains fentanyl. The spread of these counterfeit pills may explain a recent sharp increase in overdose deaths among teenagers, who are less likely to inject drugs than older people.
Pat Allen, the Oregon Health Authority director, said that, as was the case in other states with surging overdose deaths, the clear difference in 2021 had been the ubiquity of fentanyl. Children as young as 12 are considered at high risk of obtaining counterfeit pills containing fentanyl, and high schoolers are overdosing on them, believing they are opioid painkillers or anti-anxiety medication. The state was working to send naloxone tool kits to schools, similar to a program it has used in fast food restaurants, where people were overdosing in bathrooms.
Mr. Allen said he had seen an alarming phenomenon among those who overdose: They perceive the risk of fentanyl to be low, even though the actual risk is “gravely higher.”
“We’ve had an addiction issue in Oregon which we’ve known about for a long time,” he said. “This takes that existing addiction issue and makes it much more dangerous.”
In 2021, overdoses amounted to one of the leading causes of death in the United States, similar to the number of people who died from diabetes and Alzheimer’s disease, and roughly a quarter of the number of people who died from Covid-19, the third leading cause of death, according to the C.D.C.
In Vermont, which saw one of the biggest increases in overdose deaths last year, 93 percent of opioid deaths were fentanyl-related, according to Kelly Dougherty, the state’s deputy health commissioner.