In 2023, 107,543 Americans died from an overdose—over 75 thousand of those overdosed from fentanyl. This is almost double the number of people who died in car accidents or from gun homicides that year.

Fentanyl has been cut into heroin for years, but now is often mixed into meth and cocaine, fueling rising death counts for those drugs, a troubling development, considering that Americans are much more likely to try meth and cocaine than heroin.

In Canada, the numbers are similarly astronomical, and fentanyl deaths have marched upward in Australia and many European countries as well. Ten years ago, fentanyl and its analogues overtook heroin to become the deadliest drug in Sweden.

“Fentanyl is the game changer,” Special Agent in Charge James Hunt of the US Drug Enforcement Administration (DEA) told Vice News. “It’s the most dangerous substance in the history of drug tracking. Heroin and cocaine pale in comparison to how dangerous fentanyl is.”

Ben Westhoff is a best-selling investigative journalist focused on drugs, culture, and poverty. His book Fentanyl, Inc.: How Rogue Chemists Created the Deadliest Wave of the Opioid Epidemic is the bombshell first book about fentanyl. Since its publication, Westhoff has advised top government officials on the fentanyl crisis, including from the White House Office of National Drug Control Policy, U.S. Senate and House of Representatives, the U.S. embassy in Beijing, and the U.S. State Department.