Opioid addiction and abuse is one of the factors driving legacy workers’ compensation claims, and extending claim closure time. Recent California and national statistics show a decline in opioid prescribing patterns in claims, suggesting that perhaps the “opioid crisis” is no longer a crisis in claims.

An alternative hypothesis is that those addicted to opioids, remain addicted, and the “crisis” may still be present – just more hidden from view.

The supply chain seems to have shifted from pharmacies to cartels, or perhaps a mixture of the two, the combination of supply may result in a continuation of legacy claims driven mostly by addiction demands made on one supplier, or the other, or both.

In the past few years, Mexican drug cartels have been flooding the United States with methamphetamines and fentanyl, driving the supply so hard and dropping the price so low that it pushes up addiction rates and the market then demands more drugs.

Fentanyl, a synthetic opioid, is 100 times more potent than morphine.

The 2019 National Drug Threat Assessment from the DEA states that “Mexican cartels began to manufacture their own fentanyl and press the drug into pill form as the primary opioid substance, marketing the pills as ‘Mexican oxy’ to those seeking opiate-based pills on the street.”

Meth and fentanyl are both made in labs, making it easier and cheaper for cartels to produce year-round, without the land area and large staff needed for crop maintenance that heroin and cocaine require.

In the past, fentanyl had mainly been mixed into heroin to boost the high, but now it’s often pressed into small blue tablets and stamped with “M30” to closely match the color and markings of prescription oxycodone pills.

Buyers may be unaware the pills contain fentanyl, of which a 2mg dose can be fatal.

“Fentanyl and other highly potent synthetic opioids – primarily sourced from China and Mexico – continue to be the most lethal category of illicit substances misused in the United States,” the 2019 DEA report says.

The volume of fentanyl trafficked from Mexico is high, but the purity is typically low (less than 10 percent pure on average), according to the DEA.

“Conversely, fentanyl trafficked through the mail from China typically arrives in smaller quantities that are highly pure (frequently 90 percent or higher purity),” the DEA report states.

Clandestine fentanyl pill pressing operations are dotted all over the United States, according to the DEA.

“These operations are popular since traffickers can invest in as little as a kilogram of fentanyl powder and produce hundreds of thousands of counterfeit fentanyl-containing pills to generate large amounts of revenue,” the report states.

The use of the dark web and cryptocurrency has made it more difficult for law enforcement to track transactions and communications.