The number of illicit fentanyl seizures by law enforcement in the United States grew by more than 1,700 percent between 2017 and 2023, according to a new analysis. Further, the share of total fentanyl seizures that involved pills quadrupled over the same period, with the 115.6 million pills seized in 2023 representing 49 percent of total seizures.

This is the first time that such up-to-date seizure data has been published differentiating between fentanyl powder and pills, says the research team led by experts at NYU Grossman School of Medicine and the University of Florida.

Law enforcement drug seizures are used as a proxy for drug availability or supply but do not necessarily indicate the prevalence of illicit drug use. Fentanyl is a synthetic opioid up to 50 times more potent than heroin and involved in approximately two-thirds of all U.S. overdoses. More than 100,000 people continue to die from drug overdoses each year.

The findings, published online May 13 in the International Journal of Drug Policy, also indicated that fentanyl seizures varied by U.S. region. Fentanyl seizures were initially less common in the West; however, by 2023, the West had the greatest number of all seizures by weight, and 85 percent of all confiscated fentanyl pills. The greatest number of fentanyl seizures in powder form—which can easily be used to adulterate other drugs and make them deadlier—was highest in the South. While the Midwest had fewer fentanyl seizures overall, researchers saw a particularly noteworthy spike in fentanyl pill seizures there.

“About half of seized fentanyl is now in pill form, suggesting that the illicit drug landscape has rapidly changed,” said study lead author Joseph J. Palamar, MPH, PhD, an associate professor in the Department of Population Health at NYU Langone Health and deputy director of the National Drug Early Warning System (NDEWS). “Fentanyl in pill form not only makes it easier for people to initiate use, but also increases the chances that people who buy illicit pills could be unintentionally exposed to fentanyl since it is commonly present in counterfeit pills pressed to resemble oxycodone, Xanax, or even Adderall.”

How the Study Was Conducted

Palamar and colleagues analyzed annual trends in seizures of pills and powders containing fentanyl using data from the High Intensity Drug Trafficking Areas (HIDTA) program for the U.S. overall, as well as by region, from 2017 through 2023. Unlike most survey data and surveillance systems, which can lag by a year or more, HIDTA data are made available quarterly, allowing for analysis in almost real time.

The team of investigators measured eight indicators of potential shifts in illicit fentanyl supply or availability including the number of total seizures, powder seizures, pill seizures, and the total weight of seizures. They also looked at the percentage of pill seizures in comparison to total seizures.

In the U.S. overall between 2017 and 2023, there were 66,303 seizures, with 67.3 percent of fentanyl seizures being in powder form and 32.7 percent in pill form. The total number of seizures during that time period increased by more than 1,700 percent.

In 2023, states with the greatest number of seizures included Florida, Arizona, and California respectively. The highest number of pill seizures were in Arizona, Colorado, and New Mexico. The Northeast had the fewest pills seized in 2023.

The West always had the largest proportion of fentanyl pills relative to all seizures, most likely to proximity to the Mexican border, said Palamar, but his team’s findings show all regions are slowly catching up and that pills are dominating much of the fentanyl market. States with the highest percentage of seizures in pill form include New Mexico (98.4 percent), Colorado (94.8 percent), and Wyoming (93.8 percent).

One study limitation identified by Palamar was that due to the nature of HIDTA data collection, the investigators were unable to differentiate whether seizures were solely fentanyl, fentanyl combined with other drugs, or fentanyl analogs (such as carfentanil, one of the most potent opioids in existence). Even so, Palamar maintains that detection of any fentanyl in a drug seizure can be an important indicator for risk of overdose.

In addition to Palamar, co-investigators include Linda B. Cottler, PhD, MPH, and Nicole Fitzgerald at the University of Florida in Gainesville; Thomas H. Carr, at the University of Baltimore in Maryland; senior author Daniel Ciccarone, MD, MPH, at the University of California, San Francisco.

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under grant numbers U01DA051126, T32DA035167, and R01DA057289. The content of this research is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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