Massachusetts isn’t alone in the current drug overdose crisis. It’s sweeping the nation. The COVID-19 pandemic drastically worsened a drug epidemic already out of control. The collision of these two public health issues resulted in a spike in drug overdose deaths in virtually every state, culminating in a national increase of approximately 30% in 2020. And since neither addiction nor the pandemic resolve quickly or easily, matters only grew worse. Last year, more than 100,000 Americans died of a drug overdose, the highest total ever recorded by a significant margin.

But not all states were affected equally. Opioids are the primary driver of this wave of drug overdose deaths. Chiefly among these is the notorious fentanyl. And it’s hard to find a state that’s been hit harder by fentanyl in the last several years than Massachusetts, where more than twice as many people die per capita from opioids than the national average.

Fentanyl is a synthetic opioid painkiller that’s 50 to 100 times more powerful than morphine, according to Addicted.org. While the drug is prescribed legitimately for severe pain, most overdoses involve an illicit form of fentanyl. Because it’s relatively easy and cheap to produce and it’s easy to conceal ad smuggle, fentanyl has become the drug of choice for unscrupulous dealers.

Many fentanyl overdoses in Massachusetts happen to people who don’t know they’re consuming it. While they usually know they’re taking a drug, they often think they’re ingesting a different substance like heroin, cocaine, oxycodone, or various prescription opioids. Dealers lace these substances or replace them completely with fentanyl and sell them to unsuspecting users. This type of scenario has become all too common in Massachusetts, where fentanyl is the leading cause of opioid deaths.

Massachusetts has the third-highest fentanyl-related death rate in the country, second only to New Hampshire and West Virginia. As we saw during the pandemic, many factors influence opioid addiction and drug overdoses. For example, economic hardship is directly related to opioid abuse. And we know that doctor-prescribed opioids play a key role in the problem in certain states. But neither of these issues seem to be why Massachusetts stands out as having one of the worst opioid problems in the U.S.

So why have fentanyl and other illicit opioids become much more prevalent in Massachusetts?

There appears to be a regional effect at play. Opioid-related deaths are not just high in Massachusetts. They are startlingly high throughout New England. All six regional states have opioid-related death rates well above the national average. And five of the six states in New England have rates that are roughly double the national average.

Fentanyl is also relatively common in New England. Five of six New England states are among the top 10 in fentanyl-related death rates, and all six are in the top 15. And the presence of key drug trafficking routes that serve the Northeast and run through Massachusetts make it a sort of drug smuggling “hub.” By extension, the local communities around Massachusetts are often directly exposed to the newest drug trends and are impacted heavily.

Addiction is a mysterious and insidious phenomenon that we’re still struggling to understand, let alone control but understanding as much about it as possible gives us a better chance to avoid falling victim to it.

Fentanyl is the main culprit behind the wave of death plaguing Massachusetts and the country. Knowing this, resources like fentanyl test strips and overdose reversal medications like Narcan become lifesaving tools that can and should be made as accessible to residents.

Marcel Gemme is Drug and Alcohol Treatment Specialist, DATS, that has been helping people struggling with substance abuse for over 20 years. His primary focus is threefold: education, prevention and rehabilitation.