There’s a clear culprit in the rising drug overdose death count in Massachusetts — the synthetic opioid fentanyl.

More powerful and more deadly than heroin, fentanyl has sparked a new set of survival rules among people who abuse opioids. About 75 percent of the state’s men and women who died after an unintentional overdose last year had fentanyl in their system, up from 57 percent in 2015 (PDF). It’s a pattern cities and towns are seeing across the state and country, particularly in New England and some Rust Belt states.

Fentanyl may be especially lethal because it’s strong, it’s mixed with other drugs in varying amounts unknown to the user, and it can trigger an overdose within seconds. “It happens so fast, like instantly, as soon as you do the shot,” said Allyson, a 37-year-old woman who started using heroin in her late teens.
“In the past, [an overdose] was something that you saw happening, like, you could see the person start to slow down, their color would start to turn blue, and then they would go out, within 10 minutes or so,” Allyson said. With fentanyl, there’s no progression, no time to seek help. “Now it’s instant,” she said.