Supply-side Response to Declining Heroin Purity: The Fentanyl Overdose Episode of 2006

During the past decade, the purity of heroin sold in the Northeastern U.S. declined, while at the same time the availability of prescription opioids increased considerably. In 2006, illicitly produced fentanyl, an extremely potent synthetic opioid, was added to heroin sold in a handful of mostly Northeastern U.S. cities, resulting in over one thousand deaths. We argue that the introduction of fentanyl into the drug markets, the timing of overdose deaths, and the blood concentration of fentanyl in decedents was associated with trends in heroin purity. By the end of 2006, non-pharmaceutical fentanyl had largely disappeared from the drug market, due to several highly publicized busts, enhanced sentencing, and the banning of precursors used in fentanyl manufacture. The fentanyl overdose episode of 2006 can be seen as a supply-side response to declining heroin purity.