A new study from researchers at Carnegie Mellon University, RAND, and the University of Maryland may change the way public health officials approach opioid use.

The study revealed a blind spot in the field: while researchers have closely monitored factors like the number of people using opioids, the intensity of use is largely overlooked.

The takeaway? When more drugs are available and prices are lower, people will consume a far higher amount, often with greater potency. In other words, when fentanyl has flooded the market, users are often taking higher doses – and bigger risks – more frequently.

“We wanted to explore whether various populations who use opioids frequently consume roughly the same amounts per day of use, on average, or whether there is appreciable variation from place to place or from time to time,” said coauthor Jonathan P. Caulkins, professor of operations research and public policy at Carnegie Mellon’s Heinz College.

The study notes that the long-term effects of high-intensity opioid use are murky, given that the majority of research on the subject has looked at historical use when intensity was much lower. The new age of fentanyl and fentanyl-related opioid use disorder prevalence may pose different challenges than were seen with widespread prescription drug and heroin use.

Researchers reviewed the data available in 135 articles published on the subject of opioid use disorder, or OUD. To understand intensity across different types of drugs, they look at “morphine milligram equivalents.” This helps them compare the effects of a dose of copycat fentanyl to a dose of heroin to a dose of prescription hydrocodone.

The commonwealth has one of the highest per capita rates of OUD in the country at over 2.5%. According to the Attorney General’s office, the state seized three million individual doses of fentanyl and an additional 50,000 fentanyl pills from the market over a year-long period between 2023 and 2024.

The state has taken a multi-pronged approach to addressing the opioid epidemic. Settlements received from the pharmaceutical companies found responsible for fueling the crisis have been used to fund prevention and treatment programs.

Law enforcement has focused their sights on fentanyl and fentanyl copycats that have overwhelmed the state, primarily from China through Mexico. The Attorney General’s office has supported the HALT Fentanyl Act, which permanently classifies fentanyl copycats as Schedule I narcotics. It was signed into law by President Trump on Wednesday.

“Synthetic opioid manufacturers and traffickers have exploited loopholes in scheduling classifications which contributed to widespread distribution of variations of fentanyl,” Attorney General Sunday said in February. “Those variations have the same disastrous effects as fentanyl, and this office remains committed to doing everything in our power to deter trafficking in Pennsylvania communities.”

The study suggests that treatment professionals and public health officials may need to adjust their approaches to factor in a “higher baseline consumption.”

Beau Kilmer, co-Director of RAND’s Drug Policy Research Center, who coauthored the study, said there were ways to better understand OUD through the data collected.

“One is to regularly ask people who use opioids about their consumption and combine this with purity information obtained from law enforcement or drug checking services,” said Kilmer. “Another is to ask people who use opioids about their spending on opioids and combine this with law enforcement data on drug prices, accounting for variation in purity.”