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The Pew Charitable Trusts

FREDERICK, Md. — A billboard on a main highway tallies the number of residents in this mostly rural county who have overdosed on prescription painkillers, heroin and other illicit opioids this year: 96 overdoses, 15 of them fatal.

What the sign doesn’t say is that a large and growing number of those deaths are the result of fentanyl, a fast-acting drug that is 50 times stronger than heroin and can kill users within seconds. Cheap and easy to produce, it is used by drug dealers to intensify the effects of heroin and other illicit drugs, often without the users’ knowledge.

The presence of fentanyl in the illicit drug supply has put law enforcement officials and the medical community on high alert in more than a dozen states, accelerating the battle against opioids on all fronts.

States, counties and cities are responding to this latest crisis by doing more of what they already were doing: stockpiling the overdose reversal drug naloxone, funding more drug treatment, and ramping up police surveillance of drug trafficking. In addition, a handful of states are stiffening penalties for selling the lethal drug.

But even in hard hit states that have been battling fentanyl for more than three years, the death toll continues to spike. Connecticut, Illinois, Maine, Massachusetts, New Hampshire, New York, Ohio, Tennessee, West Virginia and Rhode Island were among the states hit hard by fentanyl as early as 2013.

In 2014, the powerful drug killed more than 5,000 Americans, according to the Centers for Disease Control and Prevention. The next year, nearly 10,000 Americans died of fentanyl-related overdoses. All opioids, including heroin and prescription painkillers, killed more than 33,000 people in 2015, the most recent year for which numbers are available.

Early death reports from states indicate that national data, to be released in January, will show an even steeper rise in deaths in 2016, said Matthew Gladden, an opioid investigator at the CDC.

This year and last, the deadly drug began spreading to more states. “We no longer have a situation of isolated outbreaks, but a major sustained public health challenge with the supply of fentanyl,” he said.

The sharpest spike is in Maryland, according to Gladden. “The trends there are extremely disturbing.” Other emerging hotspots include Florida, New York City and Virginia, he said.

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