More Americans are dying due to synthetic drugs like fentanyl than heroin or prescription opioids, according to a new report published in the journal JAMA.

Researchers found that roughly 46 percent of the 42,249 opioid-related overdose deaths in 2016 involved synthetic opioids; 40% were due to prescription drugs.

Fentanyl, which is 50 to 100 times more potent than opioids like morphine, heroin and oxydodone, can be prescribed by a physician for pain relief. However, most of the overdose cases resulted from the illicit production and distribution of this synthetic opioid that is often mixed with other drugs. In fact, nearly 80 percent of the deaths also involved other drugs.

Here’s the breakdown:
• Opioids: 50%
• Cocaine: 22%
• Benzodiazepines: 17%
• Alcohol: 11%
• Antidepressants: 5%

Fentanyl is tainting cocaine in at least eight states — most notably in New Hampshire, Massachusetts, and Maine — with the majority of cocaine deaths involving fentanyl, according to a BuzzFeed analysis. And the death rate from fentanyl-cocaine overdoses is especially hitting the black community— a group that hasn’t been widely impacted by the opioid crisis. Addiction experts worry that this could mean that America’s opioid epidemic is increasingly reaching a new class of drug users.

Initially when synthetic opioids showed up in the U.S., it was largely mixed with heroin,” Christopher Jones, director of the National Mental Health and Substance Use Policy Laboratory at the Substance Abuse and Mental Health Services Administration and a lead author of the report, told CNN. But now we’re seeing it mixed with cocaine, methamphetamines and other substances of abuse. And in the last couple of years we’ve seen this proliferation of counterfeit tablets that are made to look like commonly abused prescription drugs.”

This particularly concerning because people who are not regularly exposed to opioids — those who seek drugs like cocaine and Xanax and end up with fentanyl-laced products — are going to be at an increased risk of the respiratory depressant effects of opioids because they have no tolerance, adds Jones. And it can happen in mere minutes.

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