Drug overdose deaths in the United States rose substantially during a 12-month period ending in April, according to Centers for Disease Control and Prevention (CDC). Provisional data released by the CDC’s National Center for Health Statistics showed the 28.5% surge accounted for an estimated 100,306 drug overdose deaths across the country, compared to the 78,056 deaths reported during the same period the previous year.

Estimated overdose deaths caused by opioids jumped from 56,064 in the previous year to 75,673 as did fatalities attributed to synthetic opioids – primarily fentanyl – and psychostimulants including methamphetamine during the 12-month period.

Before 2016, more Americans died annually from heroin overdoses than from synthetic opioids such as fentanyl, reports Guardian UK. In the past year, fentanyl was involved in more than 60% of the overdose deaths.

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Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine, according to the CDC, which might explain its popularity with drug dealers and users. There are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl, with both considered as synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer.

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“However, most recent cases of fentanyl-related overdose are linked to illicitly manufactured 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,” the CDC says.

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Cocaine deaths also increased throughout the 12-month period.

Harm reduction groups are also dealing with severe shortages in naloxone, a medication that reverses the effects of overdoses, as they now have to pay $37 for a different generic medication or $75 for Narcan.

“To put it in stark terms, you could be saving one life or you could be saving 10 lives for the same price,” Leo Beletsky, a professor of law and health sciences at Northeastern University, told the Guardian.