The deadly surge of fentanyl in Northeast Tennessee

No other drug has ravaged the Northeast Tennessee region — and the United States at large — quite like fentanyl.Two milligrams — equal to about 10 grains of table salt — is all it takes for a potentially lethal dose of the substance. Meanwhile, a lethal dose of heroin can be anywhere from 75 to 600 mg, depending on how it is administered.If you need help for substance use disorder, these resources can connect you with treatment and training:• https://findhelpnow.org/tn/sud — find treatment providers near you• 988 Suicide and Crisis Lifeline — operators can direct you to help• Local drug prevention coalitions:Sullivan County Anti-Drug CoalitionWe Care Hawkins CountyInsight Alliance (Washington Co.)Carter County Drug PreventionACTION Coalition (Johnson Co.)Unicoi County Prevention CoalitionAcross the United States, there were about 80,000 opioid overdose deaths in 2023. Fentanyl and other similar synthetic opioids accounted for about 92% of those deaths. By comparison, heroin, which has long been considered one of the most dangerous and addictive drugs available, accounted for 5% of all opioid overdose deaths that year.Fentanyl is potent; it's cheap; and it's the primary driver behind the current phase of the opioid crisis.What is fentanyl?Fentanyl is a synthetic opioid made in labs. It can be up to 100 times more potent than morphine and up to 50 times stronger than heroin. Like all opioids, fentanyl is addictive.While it can be used medically as a prescription pain medicine, illegally made fentanyl and other synthetic opioids, not prescription drugs, have become the leaders of the nation's opioid crisis.Most opioid-related deaths are now attributable to fentanyl. The rate of overdose deaths from synthetic opioids increased by 2,100% from 2013 to 2023, according to data from the U.S. Centers for Disease Control and Prevention. In 2023, fentanyl alone accounted for more than two-thirds of all measured overdose deaths in the nation.China and Mexico have generally been credited as the primary sources for the fentanyl smuggled into the U.S. The drug is inexpensive to make — one 2019 report found that it cost anywhere from $10,000 to $90,000 per kilogram, meaning a fatal dose could be cheaper than 50 cents.Because the drug is cheap and extremely strong, it is often used to cut other street drugs like heroin and cocaine. It can even be found in pills sold online marketed for ADHD and anxiety. The potency of it — and the fact that making illegal fentanyl isn't a precise science — also means drugs are often accidentally mixed with too much fentanyl.It's impossible to know if a substance contains fentanyl unless it's tested."A lot of [patients] don't know that they're using fentanyl, because they'll come in and they'll say that they're on heroin," said Dr. Ryan Stump, medical director at Ballad Health's Overmountain Recovery. He estimated that about two-thirds of the people entering the outpatient clinic using illegal street substances are using fentanyl, whether they know it or not."A lot of them are finding it extremely hard to stop fentanyl because it is so strong and the withdrawals will hit them so quickly," Stump added.How does it affect Northeast Tenn.?While overall opioid deaths have seemingly decreased in the state and nation since their 2022-23 peak, the total fatal fentanyl overdoses in Northeast Tennessee have at least doubled in the last half decade.Appalachia has long been disproportionately impacted by the substance use disorder crisis. Stump noted that while measures like publicly available fentanyl test strips and the reviving medication naloxone have helped, barriers like stigma and a lack of insurance coverage for treatment still pose a challenge."Addiction, a lot of the time, is looked at as a flaw in a person, and it's really not," he said. "[People] either have never had treatment because they've always been afraid of being stigmatized, or they've had treatment in the past and people treated them poorly."Although men are generally twice as likely than women to die from a fentanyl overdose, Stump said his Johnson City clinic sees people from all walks of life."It can affect everybody, and it's not something to hide or shame people about," he said. "I think things are getting better, but we still definitely have a ways to go."Regional and statewide statisticsNortheast Tennessee has high rates of opioid overdose deaths when compared to the rest of the state — which already has the fourth-highest rate in the country — making the region a particular outlier among an already distressed state.Across Tennessee, opioid overdose deaths increased 3.9 times in only a decade, from 2013 to 2023. In Northeast Tennessee, opioid overdose deaths increased by 6.7 times during that same period, with some counties, such as Washington, seeing a 26-times increase.When you compare this stark increase to other large cities across the state, the disparity becomes clearer. Shelby and Davidson counties had opioid overdose deaths increase by around 4.5 times from 2013 to 2023, while Blount County, with a population similar to Sullivan and Washington, saw a 3.9-times increase.Part of the stark increase can be attributed to there being relatively few overdoses in counties such as Washington (2) and Sullivan (9) in 2013. Doubling those numbers would not require as many more deaths as it would in more populous areas with more people and, consequently, greater numbers of overdoses.Still, a 568% increase in deaths in only a decade is a troubling statistic.While overdose deaths have increased drastically since 2013, data from more recent years shows them trending downward. Twelve-month provisional data, which helps identify emerging trends, shows a downward trend beginning to emerge in late 2023 and early 2024.Due to a lack of more local data from 2024 and 2025, it is unclear whether this trend has been mirrored in Northeast Tennessee.