U.S. Overdose SurveillanceSynthetic opioids (fentanyl), the polydrug "fourth wave", and an emerging synthetic-opioid early-warning watch

— — measured live/provisional CDC modeled lag-adjusted interpretive curated watch

● National picture measuredmodeled

Total drug-overdose deaths · 12-mo ending —

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Synthetic opioids (fentanyl & analogs, T40.4)

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Total overdose deaths, 12-mo rolling (2019→now)

Synthetic opioids, 12-mo rolling

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▦ The drug landscape — what's rising, what's falling measuredmodeled

12-month rolling deaths by drug category, with change vs. 12 months earlier. Direction is the signal here, not the exact number.

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▤ By state measured

Synthetic-opioid deaths per 100,000 residents (12-mo rolling). Small states with high per-capita burden rank above large states with bigger raw counts.

Rates use 2024 Census population estimates (demographic context, not the surveillance data). A few jurisdictions are suppressed by CDC for low counts / data quality and are omitted. Rank reflects the most recent reported period per state, which can differ slightly across states.

⚠ Emerging synthetic-opioid early-warning interpretive

A curated watch list of substances reshaping the unregulated opioid supply. This is qualitative early-warning context — not a live count.

These substances mostly fall under ICD-10 T40.4 (synthetic opioids) or T40.6 (other/unspecified narcotics) and are not separately broken out in the provisional death counts above. Granular identification comes from forensic-lab data (DEA NFLIS) and CDC SUDORS toxicology, which lag roughly a year. Compiled from public early-warning sources (CDC HAN, DEA, EMCDDA EU-EWS, UNODC EWA); reflects status as of the embed date below. Naloxone reverses opioids (including fentanyl and nitazenes) but not sedative adulterants like xylazine or medetomidine.

◍ International context interpretive

The synthetic-opioid mortality crisis is concentrated in North America. There is no browser-accessible live international death-count feed (WHO, UNODC and EMCDDA data are not CORS-open and are largely report-based), so this is curated context, not live surveillance.

Sources are authoritative but reported with their own lags and methods; figures across countries are not directly comparable. Curated as of the embed date below.