May 21, 2025

About 11% of adults in the United States used illicit opioids in 2024, according to a nationally representative survey. Of those surveyed, 7.5% reported using illicitly manufactured fentanyl (IFM) at some point in the previous 12 months. The researchers said these rates are much higher than previously reported estimates, indicating that illicit opioid use may be more common than anticipated. The National Survey on Drug Use and Health, fielded by the federal Substance Abuse and Mental Health Administration (SAMHSA) in 2022, estimated that 0.3% of the population used IMF.

Illicit opioid use was higher than the national average among men, Black respondents, and younger age groups. Among men, illicit opioid use was 5.4 percentage points higher than the national estimate, and IMF use was 4.4 percentage points higher. Among Black respondents, illicit opioid use was 6.6 percentage points higher, and IMF use was 4.2 percentage points higher. Compared to adults age 55 and older, among young adults ages 18 to 34, the rate of illicit opioid use was 23.7 percentage points higher, and IMF use was 21.4 percentage points higher. Among those ages 35 to 54 years old, illicit opioid use was 17.4 percentage points higher, and IMF use was 16.1 percentage points higher.

The survey asked the respondents about their first opioid use. About 39% of those who reported illicit opioid use said that their first use was an opioid prescribed to them. Another 36% said their first use was a prescription opioid that had been prescribed to someone else. For the remaining 25%, their first opioid use was of an illicit opioid.

About 5% of the respondents who reported using illicit opioids said it was “very likely they would have an overdose due to opioid use.” Among those who used IMF, the percentage increased to 33%.

These findings were reported in Estimates of Illicit Opioid Use in the US by David Powell, Ph.D.; and Mireille Jacobson, Ph.D. The researchers surveyed 1,515 adults aged 18 to 84 who participated in a Respondi survey panel. Respondi is an online platform used in academic research. They said Respondi actively recruits panelists, who must go through a double opt-in process, and continuously checks for active engagement with the surveys. Participants in the panel are invited to take a survey, but they are not told the subject of the survey to avoid concerns about respondent selection. For this survey, the participants were asked about their use of nonprescription opioids in the past 12 months. The response options were “Yes, I intentionally used illicit opioids,” “Yes, I may have unintentionally used illicit opioids,” or “No.” Those who answered yes were asked follow-up questions.

The goal of the survey was to estimate the prevalence of illicit opioid use, including IMF, and initial opioid exposure among those reporting illicit opioid use. Of the 1,515 survey respondents, 166 reported illicit opioid use, with 116 of them reporting IMF use.

The full text of Estimates Of Illicit Opioid Use In The US was published on May 9, 2025, by JAMA Health Forum. A free abstract is available online at https://jamanetwork.com/journals/jama-health-forum/fullarticle/2833721 (accessed May 15, 2025).