In 2013, the introduction of illicitly made opioids to the drug supply marked the beginning of The Third Wave in the ongoing Opioid Epidemic. Between 1999 and 2023 in the U.S., opioid overdose mortality rates increased ten times nationwide. Furthermore, the burden of overdose death varies among racial and ethnic groups, sex, and socioeconomic status. Geographic level differences in overdose death rates are also pronounced in the United States and across Massachusetts marked by persistent income inequalities. 

This review aims to examine how illicit fentanyl contamination of the drug supply has impacted the drug overdose death rates.  In addition, there is limited research on the impact of fentanyl contamination on the overdose mortality rates within diverse groups of age, race and ethnicity, and socioeconomic status. I will conduct a review of the literature, and review state and community data from PubMed, PsychInfo, MassGov, CDC, County Health Rankings, among others to learn more about the impact of illicit fentanyl contamination. I expect to observe a significant increase in overdose-related mortality rates following the addition of illicitly-made fentanyl contamination among different geographic regions and demographic groups. I anticipate that the impact will be strongest in communities facing other health disparities.  After completing my analysis, I will make recommendations for state health departments which may include state-level recommendations for naloxone distribution, harm reduction expansion, and policies addressing structural inequities.