The data above represents deaths attributed to synthetic opioid in the state of Indiana. Death certificate data are used to track underlying and contributing cause of death, in order to understand the burden of drug overdose deaths for prevention. The underlying cause of death is the disease or injury that initiated the events leading to death while the contributing causes of death are diseases or injuries that contributed to the fatal outcome. Data are collected by the IDOH Division of Vital Records. A final dataset is provided by the IDOH, Office of Data and Analytics, Data Analysis Team and analyzed by the Division of Trauma and Injury Prevention to identify overdose deaths among Indiana residents. Deaths are reported back to the county of residence of the Indiana decedent.

Drug overdose death counts involving synthetic opioids (displayed above) include the following codes:

Underlying Cause of Death Codes: 

1. X40 to X44 - Accidental poisoning by drugs
2. X60 to X64 - Intentional self-poisoning by drugs
3. X85 - Assault by drug poisoning
4. Y10 to Y14 - Drug poisoning of undetermined intent

Contributing Cause of Death codes (for synthetic opioids): 

1.  T40.4 - Synthetic opioids

Page last updated: October 3, 2023

Drug overdose deaths can be prevented. See how CDC is working to prevent overdoses and substance use-related harms with guiding principles and strategic priorities.

Evidence-Based Strategies for Preventing Opioid Overdose

• Targeted Naloxone Distribution  
  • Naloxone – a non-addictive, life-saving drug that can reverse the effects of an opioid overdose when administered in time. Targeted naloxone distribution programs seek to train and equip individuals who are most likely to encounter or witness an overdose—especially people who use drugs and first responders— with naloxone kits, which they can use in an emergency to save a life.
• Medication-Assisted Treatment (MAT) and Medication for Opioid Use Disorder (MOUD)
  • MAT is a proven treatment for opioid use disorder. The backbone of this treatment is FDA approved medications. Methadone and buprenorphine activate opioid receptors in the brain, preventing painful opioid withdrawal symptoms without causing euphoria; naltrexone blocks the effects of opioids.
• Academic Detailing  
  • Academic detailing consists of structured visits to healthcare providers by trained professionals. They provide tailored training and technical assistance, helping healthcare providers use best practices.
• 911 Good Samaritan Laws  
  • The scope of 911 Good Samaritan Laws varies across U.S. states, but each is written with the goal of reducing barriers to calling 911 in the event of an overdose. This type of legislation may provide overdose victims and/or overdose bystanders with limited immunity from drug-related criminal charges and other criminal or judicial consequences that may otherwise result from calling first responders to the scene.
• Syringe Services Programs 
  • Syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; testing; treatment for infectious diseases; and linkage to medical, mental health, and social services.

 Source:

1. Centers for Disease Control and Prevention. (n.d.). Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States. U.S. Department of Health and Human Services. 

Synthetic opioids are substances that are synthesized in a laboratory and act on the same targets in the brain as natural opioids (e.g., morphine and codeine) to produce analgesic (pain relief) effects. In contrast, natural opioids are naturally occurring substances extracted from the seed pod of certain varieties of poppy plants. Some synthetic opioids, such as fentanyl and methadone, have been approved for medical use. Many illicitly produced synthetic opioids are more potent than morphine and heroin and thus have the potential to result in a fatal overdose (1). 

In 2021, nearly 71,000 deaths involving synthetic opioids (other than methadone) occurred in the United States. Synthetic opioid-involved death rates increased by over 22% from 2020 to 2021 and accounted for over 7 in 10 of all opioid-involved deaths in 2021. The rate of overdose deaths involving synthetic opioids was nearly 22 times higher in 2021 than in 2013 (2).

Previous reports have indicated that increases in synthetic opioid-involved deaths have been associated with the number of drug submissions obtained by law enforcement that test positive for fentanyl but not with fentanyl prescribing rates. These reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical (3, 4, 5). 

There are also fentanyl analogs, such as acetylfentanyl, furanylfentanyl, and carfentanil, which are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Recent surveillance has also identified other emerging synthetic opioids, like U-47700 (6). Estimates of the potency of fentanyl analogs vary from less potent than fentanyl to much more potent than fentanyl, but there is some uncertainty because potency of illicitly manufactured fentanyl analogs has not been evaluated in humans. Carfentanil, the most potent fentanyl analog detected in the U.S., is estimated to be 10,000 times more potent than morphine (6). 

Sources 

1. Drug Enforcement Administration (2020, April). Synthetic Opioids. U.S. Department of Justice.
2. Centers for Disease Control and Prevention. (n.d.). Fentanyl. U.S. Department of Health and Human Services. 
3. Gladden RM, Martinez P, Seth P.  Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths – 27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43.
4. Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2013-2015. Morb Mortal Wkly Rep. 2016;65(33):844-9.
5. O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:897–903.
6. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202.

IDOH Overdose Prevention Records