Author: Steven L. Byers, Ph.D.
Key Findings
- The total cost of fentanyl-related overdose deaths in Colorado is estimated to be $16 billion in 2023. This is over ten times the cost of fentanyl overdose from 2017, $1.3 billion.
- For reference, the state of Colorado collected $15.9 billion from state taxes in 2019.
- $16 billion represents 3% of Colorado’s GDP in 2023.
-
The DEA’s Rocky Mountain Field Division seized a record 425.6 kilograms of fentanyl in 2023. Two milligrams of pure fentanyl is a lethal dose. Depending on the purity of the seized drugs, 2023’s seizures could be enough to kill every Coloradan 36 times or to kill one in every three Coloradans. On average, 44% of sampled tablets seized in 2021 contained at least 2 mg of fentanyl1. Assuming this distribution, 187.3 kg of the seized tablets contain a lethal dose, or enough to kill every Coloradan 16 times. The DEA also notes purity of these tablets has been rising.
- Opioid-based drug overdose deaths are 72.3% of all drug overdose deaths in Colorado, a 30.3 percentage point increase from 42% in 2020.
- The number of reported narcotic seizures by the Colorado Bureau of Investigation has increased 104.4% from 3,367 in 2008 to 7,434 in 2023.
- The quantity (dosage units) of narcotics seized has increased 5,144% from 4,044 units in 2008 to 212,077 units in 2023.
- In 2023, there were over 1,200 drug overdose deaths from fentanyl, 59% of which resulted from illegally manufactured fentanyl. This is approximately three deaths per day on average.
- This is more than the number of people killed in homicides in Colorado in 2021, 2022, and 2023 combined (1,146).
Introduction – What is Fentanyl?
Fentanyl is a synthetic opioid that is up to fifty times stronger than heroin and one hundred times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in the U.S.
There are two types of fentanyl: pharmaceutical fentanyl and illegally made fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer.
However, most recent cases of fentanyl-related overdose are linked to illegally made fentanyl, which is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
Illegally made fentanyl (IMF) is available on the drug market in different forms, including liquid and powder.
Powdered fentanyl looks just like many other drugs. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids. Fentanyl-laced drugs are extremely dangerous, as many people may be unaware that their drugs are laced with fentanyl.
In its liquid form, IMF can be found in nasal sprays, eye drops, and dropped onto paper or small candies.
Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. Even in small doses, it can be deadly. The CDC estimates two milligrams of fentanyl is enough to provide a lethal dose. Over 150 people die every day [nationally] from overdoses related to synthetic opioids like fentanyl.[i] In Colorado, on average, approximately 3 people die every day from synthetic opioids.
For comparison, an average of 382 Coloradans per year were victims of homicide 2021-2023.
State Public Safety Competitiveness Index and Drug Overdose Deaths
Drug overdoses play a critical role in how residents and would-be residents consider Colorado an attractive place to play and work.
CSI produces a State Public Safety Competitiveness Index for all fifty states and the District of Columbia consisting of five separate indices that capture distinct aspects of public safety:
- Public safety spending per capita
- Drug overdose deaths
- Police per capita
- Crime rate
- Homelessness
Each index is ranked relative to all fifty states and the District of Columbia. Then the five ranked metrics are equally weighted and summed. Colorado’s State Public Safety Competitiveness Index was 74 in 2011, then declined to 73 in 2023. An increase in the State Public Safety Competitiveness Index is a positive qualitative change – i.e., the state is more competitive as the index approaches one hundred. Colorado’s Public Safety Competitiveness Index shows Colorado’s relative ranking decreased seven spots from 24th to 31st among states and Washington, D.C. from 2011 to 2023.
Figure 1 shows the Drug Overdose Competitiveness Index and the underlying metric for Colorado. The underlying metric, drug overdose deaths per capita, nearly doubled from 0.0167% in 2011 to 0.0312% in 2023 (a 0.015 percentage point increase).
Despite this increase, the Drug Overdoses Deaths per Capita competitiveness Index increased from 71 in 2011 to 75 in 2023. This is only because drug overdose deaths per capita increased more in some other states. Despite the improvement relative to other states, within Colorado the problem is getting much worse.
Figure 1 – Colorado Public Safety Competitiveness Index and Drug Overdoses
Drug Overdose Deaths in Colorado
Based on data from the Centers for Disease Control and Prevention, Figures 2 and 3 show the increase in drug overdose deaths from April 2015 through November 2023 and overdose deaths by drug type from August 2018 through November 2023.
CDC Opioid Classifications are defined as follows:
- 0 – Opium.
- 1 – Heroin.
- 2 – Other opioids (semi-synthetic).
- 3 – Methadone.
- 4 – Other synthetic narcotics (fentanyl and fentanyl analogues are classified under T40.4). T40.4 also includes other synthetic opioids such as Tramadol and Demerol).
- 6 – Other and unspecified narcotics.
The total number of drug overdose deaths increased 114.4% from 913 in 2015, to 1,957 in 2023.
Figure 2 – Provisional Drug Overdose Deaths by Drug or Drug Type – Colorado
Fentanyl falls within the CDC drug class T40.1, their data shows the increase in drug overdoses in Colorado due to T4041 drugs increased 833.1% form 130 in 2018 to 1,213 in 2023. Fentanyl is one drug within this class but is a large share of those drugs. Total overall drug overdose deaths increased from 1,004 in 2018 to 1,957 in 2023, a 94.9% increase.
Figure 3 – Provisional Drug Overdose Deaths by Drug or Drug Type Change, 2018-2023 – Colorado
| 12-Month-ending Provisional Number of Drug Overdose Deaths by Drug or Drug Class – Colorado | |||||||
| 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | % Change 2018-2023 | |
| Synthetic opioids, excl. methadone (T40.4) | 130 | 251 | 586 | 987 | 992 | 1,213 | 833.1% |
| Heroin (T40.1) | 234 | 218 | 228 | 190 | 64 | 38 | -83.8% |
| Natural & semi-synthetic opioids (T40.2) | 224 | 238 | 270 | 290 | 221 | 196 | -12.5% |
| Number of Drug Overdose Deaths | 1,004 | 1,100 | 1,512 | 1,917 | 1,856 | 1,957 | 94.9% |
| Cocaine (T40.5) | 133 | 135 | 225 | 274 | 264 | 290 | 118.0% |
| Methadone (T40.3) | 57 | 37 | 66 | 57 | 64 | 45 | -21.1% |
| Natural & semi-synthetic opioids, incl. methadone (T40.2, T40.3) | 271 | 265 | 330 | 339 | 274 | 236 | -12.9% |
| Opioids (T40.0-T40.4, T40.6) | 568 | 644 | 987 | 1300 | 1207 | 1375 | 142.1% |
| Natural, semi-synthetic, & synthetic opioids, incl. methadone (T40.2-T40.4) | 356 | 446 | 809 | 1179 | 1172 | 1351 | 279.5% |
| Total Number of Deaths | 39,147 | 40,105 | 47,595 | 49,137 | 47,661 | 46,045 | 17.6% |
| Psychostimulants with abuse potential (T43.6) | 330 | 367 | 537 | 760 | 728 | 882 | 167.3% |
| Source: Center for Disease Control and Prevention | |||||||
According to the Colorado Department of Public Health and Environment there were 222 fentanyl related deaths in 2019, 540 in 2020, 912 in 2021, and 920 in 2022.[ii]
According to data from the Centers for Disease Control and Prevention shown in Figure 4, drug overdose deaths in Colorado from illegally manufactured fentanyl were 558 in 2020, 974 in 2021, and 981 in 2022.[iii] Opioid based drug overdose deaths are 72.3% of all drug overdose deaths in Colorado, a 30.3 percentage point increase from 42% in 2020. Illegally manufactured fentanyl accounts for 59% of all drug overdose deaths in 2023, a 17-percentage point increase from 2020.
Figure 4 -Drug Overdose Deaths
| Fentanyl Related Drug Overdose Deaths | |||
| 2020 | 2021 | 2022 | |
| All Drugs Deaths | 1329 | 1712 | 1662 |
| Opioids Percent Death Rate | 976 | 1300 | 1201 |
| Illegally-Made-Fentanyl Deaths | 558 | 974 | 981 |
| Illegally-Made-Fentanyl with no other opioids or stimulants Deaths | 214 | 405 | 410 |
| Illegally-Made-Fentanyl and Methamphetamine Deaths | 78 | 206 | 268 |
| Illegally-Made-Fentanyl and Cocaine Deaths | 117 | 138 | 123 |
| Drug Overdose Death Rates per 100,000 | |||
| 2020 | 2021 | 2022 | |
| All Drugs Death Rate | 22.4 | 28.7 | 27.7 |
| Opioids Death Rate | 16.3 | 21.7 | 19.8 |
| Illegally-Made-Fentanyl Death Rate | 9.3 | 16.3 | 16.1 |
| Drug Overdose Death Percents | |||
| 2020 | 2021 | 2022 | |
| All Drugs Death Percent | 100% | 100% | 100% |
| Opioids Death Percent | 42.0% | 75.9% | 72.3% |
| Illegally-Made-Fentanyl Death Percent | 42% | 56.9% | 59.0% |
| Illegally-Made-Fentanyl with no other opioids or stimulants Death Percent | 16.1% | 23.7% | 24.7% |
| Illegally-Made-Fentanyl and Methamphetamine Death Percent | 8.8% | 12.0% | 16.1% |
| Illegally-Made-Fentanyl and Cocaine Death Percent | 8.8% | 8.1% | 7.4% |
| Source: Centers for Disease Control and Prevention, SUDORS Dashboard: Fatal Overdose Data | |||
Narcotics Seizures in Colorado
The Drug Enforcement Agency Rocky Mountain Field Division’s (RMFD) 2023 year in review reported record fentanyl seizures in calendar year 2023.[iv] The RFMD is responsible for 450,000 square miles of territory with thirteen offices across Colorado, Utah, Wyoming, and Montana. In 2023, the RMFD seized more fentanyl pills than any previous year. Seizure statistics by state are shown in Figure 5.
Colorado had the most fentanyl seizures by the RMFD by far with 425.6 kilograms, enough to kill everyone in the state thirty-six times over. This is followed by Utah with 119.5 kilograms, Montana with 17.87 kilograms, and Wyoming with 4.58 kilograms. The total for the RMFD region was 567.24 kilograms, enough to kill 86% of all Americans.
Figure 5 – DEA Rocky Mountain Field Division Fentanyl Seizures in 2023
| DEA Rocky Mountain Field Division Fentanyl Seizures in 2023 | ||||||
| Quantity Seized | Milligram
Equivalent |
Lethal Dosage | Potential Deaths (people) | Population of State | Potential Deaths per Person | |
| Colorado | 425.6 kg | 425,600,000 mg | 2 mg | 212,800,000 | 5,839,926 | 36.44 |
| Montana | 17.87 kg | 17,870,000 mg | 2 mg | 8,935,000 | 1,122,867 | 7.96 |
| Utah | 119.3 kg | 119,300,000 mg | 2 mg | 59,650,000 | 3,380,800 | 17.65 |
| Wyoming | 4.58 kg | 4,580,000 mg | 2 mg | 2,290,000 | 581,381 | 3.94 |
| Total | 567.24 kg | 567,240,000 mg | 2 mg | 283,620,000 | 10,924,974 | 25.96 |
David Olesky, Acting Special Agent in Charge for DEA’s RMFD said, “Fentanyl continues to be the deadliest drug threat facing our nation. The DEA Rocky Mountain Field Division, in collaboration with our federal, state, and local partners, prevented more than 3.4 million fentanyl pills from reaching our communities in the calendar year 2023. While the significant increase in fentanyl seizures across the region demonstrates the outstanding work of our agents and partners in law enforcement are doing, the numbers also reveal the extent to which the cartels continue to flood our nation with this poison….”[v]
Another source for the amount of fentanyl seizures over time is the Colorado Bureau of Investigations Colorado Crime Stats which continuously collects crime data from all law enforcement agencies in the state, validates the data, and reports it. The data does not specifically isolate fentanyl from other narcotics, but since fentanyl is a large share of total narcotics it offers an indication of the growth in seizures over time.
In 2008, the number of drug seizure reports for narcotics was 3,367 with 4,044 units seized. By 2023 the number of reports had grown to 7,434 an increase of 120.8%, and the units seized increased to 212,077, a 5,144% increase, see Figure 6.
Figure 6- Narcotics Seizures in Colorado (Colorado Crime Stats)
The Economic Cost of an Opioid Overdose
The Center for Disease Control and Prevention (CDC) methodology from “State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose – United States, 2017”[vi] was used to estimate the cost of an opioid overdose in Colorado. The CDC estimated the cost of fatal opioid overdoses for thirty-eight states and DC in 2017. For Colorado, they found the total cost of all fatal opioid overdoses in 2017 to be over $6.7 billion. The CDC used a case count of 578 fatal opioid overdoses, a per death cost of $11.5 million. Using this same approach, CSI estimated the cost per death and total costs in 2018 through 2023 by inflating the per death costs in each category by the Personal Consumption Expenditure Price Index (excluding energy and food). This raises the cost per death from $11.5 million to $16.1 million. The total cost of to Colorado of any type of fatal opioid overdose in 2023 was approximately $16 billion. Fentanyl alone accounted for 72.3% of all opioid overdose costs.
| Total Economic Cost of Any Opioid Overdose Death in Colorado | |||||||
| Number of Opioid Overdose Deaths | Healthcare Costs | Lost Productivity | Value of Statistical Life Lost | Total Cost per Death | Total Cost for all Deaths | Total Cost Attributed to Fentanyl Overdose | |
| 2017 | 578 | $5,536 | $1.4 Million | $10.1 Million | $11.5 Million | $6.7
Billion |
$1.3
Billion |
| 2018 | 543 | $5,749 | $1.5 Million | $10.5 Million | $12.0 Million | $6.5
Billion |
$2.3
Billion |
| 2019 | 620 | $6,025 | $1.6 Million | $11.0 Million | $12.6 Million | $7.8
Billion |
$4.4
Billion |
| 2020 | 976 | $5,873 | $1.5 Million | $10.7 Million | $12.2 Million | $11.9
Billion |
$8.5
Billion
|
| 2021 | 1300 | $6,589 | $1.7 Million | $12.0 Million | $13.7 Million | $17.8
Billion |
$11.1
Billion |
| 2022 | 1207 | $7,294.2 | $1.8 Million | $13.3 Million | $15.2 Million | $18.3
Billion |
$13.2 Billion |
| 2023 | 1375 | $7,735.3 | $2.0 Million | $14.1 Million | $16.1 Million | $22.1
Billion |
$16
Billion |
Recent State Legislation Related to Fentanyl
In 2022, the Colorado State Legislature passed HB22-1326, the Fentanyl Accountability and Prevention Act. The legislation was a response to rising fentanyl overdose deaths in the state. The bill increases penalties for possessing or distributing fentanyl and funds drug treatment and education programs.
HB22-1326 comes after the passage of HB19-1263 which made possession of four grams or less of most drugs, including fentanyl, a misdemeanor rather than a felony.
Despite the increasing death toll from fentanyl, there was scant legislative action in 2024 addressing the problem. Legislators introduced HB24-1306 in 2024 – Concerning an increase in the criminal penalty associated with possession of synthetic opiates. The Bill summary is as follows:
Under current law, the knowing possession of any material, compound, mixture, or preparation that weighs more than one gram and not more than 4 grams and contains any quantity of fentanyl, carfentanil, benzimidazole opiate, or an analog thereof, is a level 4 drug felony; except that, if a defendant shows supporting evidence to establish that the defendant made a reasonable mistake of fact and did not know that the controlled substance contained fentanyl, carfentanil, benzimidazole opiate, or an analog thereof, the matter must be submitted to the finder of fact in the form of interrogatory included in the verdict form. If the finder of fact determines the defendant made a reasonable mistake of fact, the defendant commits a level 1 drug misdemeanor. The bill eliminates this provision.
Under current law, the knowing possession of any material, compound, mixture, or preparation that weighs not more than one gram and contains any quantity of fentanyl, carfentanil, benzimidazole opiate, or an analog thereof, is a level 1 drug misdemeanor; except that a fourth or subsequent offense is a level 4 drug felony. The bill eliminates this provision.
Effective July 1, 2024, the bill makes the possession of any material, compound, mixture, or preparation that contains any quantity of fentanyl, carfentanil, benzimidazole opiate, or an analog thereof, a level 4 drug felony.
HB24-1306 did not pass.
Bottom Line
Colorado’s fentanyl problem is growing, and it is increasingly costly. The Colorado State Legislature has failed to pass laws that are designed to deter illegal fentanyl users, producers, and distributors.
Colorado’s Public Safety Competitiveness relative to other states is middling among the nation’s states and the District of Columbia. Drug overdose deaths are a component of public safety and the increasing problems surrounding fentanyl are contributing to the decline in Colorado’s Public Safety.
To encourage the migration and longevity of residents and businesses, leaders should strive to put Colorado among the nation’s best with regards to responsiveness to a critical nationwide public health issue.
[i] https://www.cdc.gov/stop-overdose/caring/fentanyl-facts.html.
[ii] https://cohealthviz.dphe.state.co.us
[iii] https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
[iv] https://www.dea.gov/press-releases/2024/01/31/year-review-dea-rocky-mountain-field-division-sees-record-year-fentanyl
[v] https://www.dea.gov/press-releases/2024/01/31/year-review-dea-rocky-mountain-field-division-sees-record-year-fentanyl
[vi] Luo F, Li M, Florence C. State-Level Economic Costs of Opioid Use Disorder and Fatal Opioid Overdose — United States, 2017. MMWR Morb Mortal Wkly Rep 2021;70:541–546. DOI: http://dx.doi.org/10.15585/mmwr.mm7015a1.