Abstract
Introduction:
Law enforcement seizure data can indicate potential shifts in drug availability. We examined trends in the size of illicit fentanyl seizures in the United States from 2018 through 2023.
Methods:
Using national High Intensity Drug Trafficking Areas data, we examined trends in the weight of fentanyl powder and number of fentanyl-containing pills per seizure with a focus on federal and other common state-level weight cutoffs that indicate various levels of trafficking (e.g., 1–4 g, 40–399 g, ≥400 g).
Results:
Between 2018 and 2023, the plurality of fentanyl powder seizures weighed 40–399 g (27.7%), followed by seizures weighing 4–39 g (25.8%), 1–4 g (18.6%), ≥400 g (17.4%), and <1 g (10.4%). During this period, there was a decrease in the percentage weighing ≥400 g (annual percentage change [APC] = –5.3, 95% confidence interval [CI] –9.4, –1.0) and an increase in the percentage weighing 1–4 g (APC = 5.6, 95% CI 3.2, 8.1). With respect to fentanyl pill seizures, the plurality contained 40–399 pills (10 = 1 g; 25.4%), followed by 400–3999 (21.8%), <10 pills (20.4%), 10–39 pills (18.6%) and ≥4000 pills (13.8%). During this period, there was a decrease in seizures of <10 pills (APC = –12.6, 95% CI –23.2, –0.7) and increases in seizures containing 400–3999 (APC = 14.0, 95% CI 5.3, 23.1) and ≥4000 pills (APC = 12.6, 95% CI 7.4, 17.8).
Discussion and Conclusions:
The size of fentanyl seizures varies greatly, with a sizeable portion legally classified as drug trafficking. While the weight of fentanyl powder seizures is decreasing, the size of pill seizures is increasing. The increasing availability of fentanyl pills in particular needs to be monitored to inform prevention and harm reduction efforts.
Keywords: drug seizures, fentanyl, opioids
1 |. INTRODUCTION
Drug overdose deaths have been increasing in the United States, with 73,838 involving synthetic opioids such as fentanyl recorded in 2022 [1]. While the percentage of intentional versus unintentional fentanyl exposure in these cases is unknown, unintentional exposure can occur when drug products (not limited to illegal opioids) are adulterated, contaminated or replaced with fentanyl [2]. Further, counterfeit prescription pills containing fentanyl have been estimated to now make up about 50% of the illicit fentanyl supply [3]. Younger people in particular are at risk for death involving use of such counterfeit pills [4] and paediatric fatal exposures to fentanyl have been increasing, with fentanyl linked to over 4000 fatal paediatric deaths between 2017 and 2021 [5]. Law enforcement interdiction has been a method of attempting to disrupt the illicit fentanyl supply to the public [6, 7], although drug arrests have been criticised as a method of harm prevention [8]. With policy debates aside (e.g., regarding decriminalisation and legalisation), fentanyl seizure data can still provide important information regarding availability of illicit fentanyl to the public [2, 9].
Drug seizure data have been increasingly used to estimate characteristics of drug markets and to predict opioid-related deaths [10–14]. While the link between seizures and drug-related deaths is becoming clearer, a limitation is that studies examining seizure data have tended to focus on counts with little attention paid to seizure size (e.g., weight) [15]. We believe such a focus would not only add nuance to such studies, but would also help inform research regarding arrest disparities, as information is needed regarding possession or trafficking small versus large amounts of the drug. For example, in the United States, at the federal level, trafficking <40 g of fentanyl has no mandatory minimum sentencing penalty, but trafficking 40–399 g triggers a 5-year mandatory minimum and trafficking ≥400 g triggers a 10-year mandatory minimum [16]. States have varying guidelines, but many also include possession cutoffs of <1 g and 1–4 g as triggers for lower-level felonies, with larger amounts typically used to indicate intention to distribute.
In this analysis, we examine trends in fentanyl seizures (of fentanyl-containing powder and of fentanyl-containing pills) based on such common sentencing cutoffs in attempt to inform future research on links to deaths and on debates regarding criminal justice reform.
2 |. METHODS
2.1 |. Procedure
Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to assist federal, state, local and tribal law enforcement agencies in areas determined to be areas with critical drug trafficking activity. There are 33 HIDTAs which oversee counties in 50 states and the District of Columbia. HIDTAs encourage collaboration among law enforcement agencies with a goal to disrupt and dismantle drug trafficking organisations. HIDTAs collect data on drug seizures made by participating agencies, and the HIDTA Performance Management Process collects data submitted quarterly from all HIDTAs. We analysed data from recorded fentanyl seizures in the United States and examined trends in weight/size of seized drug product containing fentanyl from national HIDTA data from 2018 to 2023.Analyses were limited to seizures of fentanyl in powder or pill form and seizures of fentanyl in liquid and patch form were excluded. We did not focus on earlier years because the number of pill seizures was relatively rare (<150 per year, nationally) which would not allow us to examine proportions of seizure size with confidence.
2.2 |. Measures
Based on federal and common local government definitions, if a seized drug contains fentanyl (with or without other substances mixed in), the total weight of the combined drug is assigned that weight in fentanyl [16]. Based on federal [16] and common local trafficking criminal offence cutoffs, we examined the prevalence of the weight of fentanyl seizures overall and by year based on the following cutoffs: <1 g, ≥1 g, 1–4 g, ≥4 g, 4–39 g, <40 g, ≥40 g, 40–399 g and ≥400 g. These weights are based on both the weight of powder and pills seized. Given that internal HIDTA data suggest that the weight of 10 pills≈1 g, for calculations, 10 pills = 1 g, and we computed separate additional calculations for fentanyl pills corresponding to the aforementioned cutoffs: <10, ≥10, 10–39, ≥40, 40–399, ≥400, 400–3999 and ≥4000 pills.
2.3 |. Statistical analysis
First, we calculated the prevalence of seizure weights according to specified cutoffs, overall, and by year. Then, trends were computed using Joinpoint 5.0 software. Rather than focusing on possible joinpoints, we focused on overall changes across years based on the annual percentage change (APC). For count data (the number of seizures per weight group), Poisson models were specified under the assumption of non-constant variance or heterogeneity over time. For percentage change across time (for each weight group relative to the overall number of seizures), errors were assumed to have constant variance. Significance for all models was determined at the level of α = 0.05. This study did not involve human subjects and was exempt from review from the New York University Langone Medical Center institutional review board.
3 |. RESULTS
Between 2018 and 2023, there were 64,955 recorded fentanyl seizures, with 43,442 in powder form and 21,513 in pill form (33.1% of all seizures). As shown in Table 1, the plurality of powder fentanyl seizures (2018–2023 aggregated) weighed 40–399 g (27.7%), followed by 4–39 g (25.8%), 1–4 g (18.6%), ≥400 g (17.4%) and <1 g (10.4%). While the number of seizures within each cutoff increased from 2018 through 2023 ( p values <0.05), with respect to percentages of each cutoff relative to all seizures, there was an increase in the percentage of seizures weighing 1–4 g (by 38.5%, APC = 5.6, 95% confidence interval [CI] 3.2, 8.1) and a decrease in the percentage weighing ≥400 g (by 24.7%, APC = –5.3, 95% CI –9.4, –1.0). With respect to pill seizures, the plurality contained 40–399 pills (25.4%), followed by 400–3999 (21.8%), <10 (20.4%), 10–39 (18.6%) and ≥4000 pills (13.8%). While the number of pill seizures within each cutoff increased from 2018 through 2023 ( p values <0.05), with respect to percentages of each cutoff relative to all pill seizures, there was an increase in the percentage of seizures containing 400–3999 pills (by 90.9%, APC = 14.0, 95% CI 5.3, 23.1) and in seizures containing ≥4000 pills (by 97.8%, APC = 12.6, 95% CI 7.4, 17.8). Figure 1 presents the distribution of seizure size by year and by powder versus pill form (Table S1, Supporting Information, presents the raw data).
TABLE 1.
Trends in the total weight of fentanyl powder seizures and in the number of seized pills containing fentanyl in the United States, 2018–2023.
| Counts |
Percentages |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Change from 2018 through 2023 |
Change from 2018 through 2023 |
|||||||||
| Total powder weight | Total, N (2018–2023) | 2018, N | 2023, N | Relative change % | APC (95% CI) | Average % (2018–2023) | 2018% | 2023% | Relative change % | APC (95% CI) |
|
| ||||||||||
| <1 g | 4536 | 205 | 994 | 384.9 | 33.8 (–4.0, 117.3) | 10.4 | 11.7 | 8.3 | −28.8 | −6.2 (–15.9, 4.7) |
| ≥1 g | 38,906 | 1554 | 10,985 | 606.9 | 46.1 (25.7, 86.2)a | 89.6 | 88.3 | 91.7 | 3.8 | 0.7 (–0.3, 1.7) |
| 1–4 g | 8083 | 262 | 2471 | 843.1 | 50.1 (22.8, 107.0)a | 18.6 | 14.9 | 20.6 | 38.5 | 5.6 (3.2, 8.1)a |
| ≥4 g | 30,823 | 1292 | 8514 | 559.0 | 45.1 (26.1, 81.2)a | 71.0 | 73.5 | 71.1 | −3.2 | −0.5 (–2.2, 1.3) |
| 4–39 g | 11,229 | 420 | 3316 | 689.5 | 48.8 (30.4, 85.5)a | 25.8 | 23.9 | 27.7 | 16.0 | 3.0 (–1.1, 7.3) |
| <40 g | 23,848 | 887 | 6781 | 664.5 | 42.5 (13.2, 105.2)a | 54.9 | 50.4 | 56.6 | 12.3 | 2.1 (–0.9, 5.1) |
| ≥40 g | 19,594 | 872 | 5198 | 496.1 | 40.1 (22.1, 73.1)a | 45.1 | 49.6 | 43.4 | −12.5 | −2.3 (–5.2, 0.6) |
| 40–399 g | 12,027 | 485 | 3212 | 562.3 | 44.9 (24.0, 85.9)a | 27.7 | 27.6 | 26.8 | −2.7 | −0.2 (–2.2, 1.8) |
| ≥ 400 g | 7567 | 387 | 1986 | 413.2 | 40.1 (22.1, 73.1)a | 17.4 | 22.0 | 16.6 | −24.7 | −5.3 (–9.4, –1.0)a |
|
| ||||||||||
| Counts |
Percentages |
|||||||||
| Change from 2018 through 2023 |
Change from 2018 through 2023 |
|||||||||
| Number of pills | Total N (2018–2023) | 2018, N | 2023, N | Relative change % | APC (95% CI) | Average % (2018–2023) | 2018% | 2023% | Relative change % | APC (95% CI) |
|
| ||||||||||
| <10 pills | 4391 | 91 | 1807 | 1885.7 | 69.5 (60.2, 89.7)a | 20.4 | 31.2 | 15.7 | −49.7 | −12.6 (–23.2, –0.7)a |
| ≥10 pills | 17,124 | 201 | 9728 | 4739.8 | 121.4 (111.9, 138.6)a | 79.6 | 68.8 | 84.3 | 22.5 | 4.4 (1.3, 7.6)a |
| 10–39 pills | 4005 | 68 | 2024 | 2876.5 | 100.4 (92.4, 116.1)a | 18.6 | 23.3 | 17.5 | −24.7 | −3.2 (–11.0, 5.3) |
| ≥40 pills | 13,119 | 133 | 7704 | 5692.5 | 129.0 (118.4, 151.4)a | 61.0 | 45.5 | 66.8 | 46.6 | 7.4 (3.7, 11.2)a |
| 40–399 pills | 5468 | 71 | 2969 | 4081.7 | 110.3 (100.8, 134.4)a | 25.4 | 24.3 | 25.7 | 5.9 | 0.9 (–1.5, 3.4) |
| <400 pills | 13,862 | 230 | 6800 | 2856.5 | 92.7 (85.7, 107.6)a | 64.4 | 78.8 | 59.0 | −25.2 | −5.1 (–7.4, –2.9)a |
| ≥400 pills | 7651 | 62 | 4735 | 7537.1 | 145.3 (130.8, 176.5)a | 35.6 | 21.2 | 41.0 | 93.3 | 13.3 (8.2, 18.7)a |
| 400–3999 pills | 4682 | 40 | 3016 | 7440.0 | 156.3 (135.4, 202.0)a | 21.8 | 13.7 | 26.1 | 90.9 | 14.0 (5.3, 23.1)a |
| ≥4000 pills | 2969 | 22 | 1719 | 7713.6 | 129.6 (119.9, 153.9)a | 13.8 | 7.5 | 14.9 | 97.8 | 12.6 (7.4, 17.8)a |
Note: The percentage of total is relative to the total number of seizures and average percentage is the average percentage across years. Abbreviations: APC, annual percentage change; CI, confidence interval.
Indicates that the APC was significantly different from zero at the alpha = 0.05 level.
FIGURE 1.
Size of fentanyl seizures in the United States between 2018 and 2023.
4 |. DISCUSSION
According to HIDTA seizure data, there is a wide range in the amount of fentanyl typically seized in the United States. Fentanyl seizures of almost all sizes increased between 2018 and 2023, but relative to all seizures, seizures of powder fentanyl weighing ≥400 g decreased, and seizures of 400–3999 or ≥4000 pills increased. This suggests that while the number of seizures is increasing, the larger seizures of powder are beginning to be replaced with large pill seizures. Counterfeit pills containing fentanyl are of particular concern, as these have great potential to reach drug consumers who were not expecting to be exposed to fentanyl.
Recent research suggests that trends in opioid seizures are positively associated with trends in opioid-related deaths [10–14]. Hypotheses regarding this association vary. Some hypotheses suggest that seizures indicate drug availability, which may lead to overdoses [10]. Others suggest that people who use may overdose as a result of having to contend with new sellers or products after seizures [13]. While the link between seizures and drug-related deaths is becoming clearer, a limitation is that studies examining seizure data have tended to focus on counts with little attention paid to seizure size (e.g., weight) [15]. We believe that focusing on seizure size in addition to seizure counts may add much needed nuance to such studies, especially in paediatric populations [5] that appear particularly susceptible to unintentional exposures via pills containing fentanyl [17].
4.1 |. Limitations
It is unknown to what extent seizures truly indicate illicit drug availability and how generalisable this indicator is to the US population. While HIDTA data has a large overlap with Drug Enforcement Administration National Forensic Laboratory Information System (NFLIS) seizure data, NFLIS has recorded a greater number of seizures [2]. This is in part due to HIDTA categorising each seizure as a single seizure, and NFLIS focuses on ‘submissions’, which can contain multiple sections of a single seizure coded as multiple submissions. Seized powders and pills were typically not tested for percent purity across HIDTAs, which can be a limitation when a study aims to assess overdose risk; however, in this analysis, we used the federal sentencing definitions in which if a drug product tests positive, the weight of the full product is recorded as fentanyl [16]. Further, testing often could not differentiate between fentanyl and fentanyl analogues, which can vary in potency.
5 |. CONCLUSIONS
Given the wide range of weights of fentanyl seizures, with a sizeable portion legally classified as drug trafficking, it is important to consider seizure weight and not just seizure counts when examining relations between overdoses and deaths. In addition, we believe results can further contribute to debate regarding criminal justice reform, as the prevalence of large seizures indicates a large portion of seizures indicative of trafficking as opposed to mere possession.
Supplementary Material
ACKNOWLEDGEMENTS
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers R01DA057289 and U01DA051126. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.
Funding information
National Institute on Drug Abuse, Grant/Award Numbers: R01DA057289, U01DA051126
Footnotes
CONFLICT OF INTEREST STATEMENT
Joseph J. Palamar has consulted for the Washington-Baltimore High Intensity Drug Trafficking Areas program. The authors declare no other potential conflicts of interest. The authors alone are responsible for the content and writing of this paper.
AUTHOR CONTRIBUTIONS
Joseph J. Palamar: Conceptualisation, Methodology, Investigation, Data curation, Formal analysis, Writing – Original Draft, Funding Acquisition. Nicole D. Fitzgerald: Formal analysis, Data curation, Writing – Review and Editing. Thomas H. Carr: Investigation, Writing – Review and Editing.
SUPPORTING INFORMATION
Additional supporting information can be found online in the Supporting Information section at the end of this article.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.