A new RAND survey reveals illicit fentanyl use in the U.S. is 25 times higher than federal estimates, exposing deep flaws in how America tracks and tackles the opioid crisis.
At a Glance
- A RAND survey found 7.5% of adults used illicit fentanyl in the past year
- This is 25 times higher than official government estimates
- High-risk groups like inmates and the homeless are often excluded from federal data
- 39% of users first encountered opioids via prescriptions
- Researchers call for better data collection and harm reduction tools
Survey Exposes Hidden Crisis
A new survey by RAND has revealed that 7.5% of American adults reported using illicitly manufactured fentanyl (IMF) in the past year—a figure 25 times higher than current estimates from the federal National Survey on Drug Use and Health. Conducted online, the anonymous survey was designed to elicit more honest responses, especially from demographics typically underrepresented in official counts.
Critics have long argued that government methods underreport opioid use by omitting high-risk populations, including incarcerated people and the homeless. RAND researchers David Powell and Mireille Jacobson stress that more inclusive data gathering is vital to understanding the full scope of this epidemic.
Watch a report: Why Official Fentanyl Data May Be Failing Us – YouTube
Roots of Use and Awareness
Beyond usage rates, the RAND study sheds light on how the crisis takes hold. Among those using illicit opioids, 39% were first exposed through legally prescribed medication, while another 36% began with non-prescribed pills. These findings highlight the complex interplay between legal and illegal opioid channels—and the pressing need for preventative education and oversight in medical settings.
According to Powell and Jacobson, “most people using IMF recognize the heightened risk of overdose.” Nearly 83% of users understood the likelihood of overdose but continued use, suggesting a window for harm reduction interventions. They argue that increased access to naloxone and fentanyl test strips—available over the counter—could offer immediate life-saving benefits.
A Systemic Undercount
RAND’s findings echo long-standing concerns from public health leaders. The Centers for Disease Control and Prevention (CDC) has reported that drug overdoses are now the leading cause of injury-related death in the U.S., with synthetic opioids like fentanyl driving the surge. In 2015 alone, over 52,000 Americans died from overdoses—a figure that has only grown in subsequent years.
By omitting key populations and relying on outdated methodologies, official data may be significantly underplaying the nation’s most lethal public health crisis. RAND’s survey joins a chorus of studies pointing to this systematic undercount and its real-world policy consequences.
Next Steps for Policy
The findings call for a complete overhaul of federal data collection frameworks. Public health officials and lawmakers must prioritize modernized, inclusive surveys that reflect current patterns of opioid misuse. Tools like anonymous digital polling, targeted outreach to high-risk groups, and integration of local overdose data could provide a more accurate picture.
As RAND notes, “A number of previous studies have reported higher rates of illicit opioid use, challenging the accuracy of the federal estimate].” Without action, public policy risks falling further behind a crisis already claiming tens of thousands of lives each year.
With fentanyl use now revealed at pandemic scale, the need for credible data—and immediate, evidence-based response—has never been more urgent.
