On 19 January 2018, the medical examiner-coroner for the county of Los Angeles said musician Tom Petty died from an accidental drug overdose as a result of mixing medications that included fentanyl, acetyl fentanyl, and despropionyl fentanyl (among others). He was reportedly treating "many serious ailments" that included a broken hip. In 2018, American rapper Mac Miller died from an accidental overdose of fentanyl, cocaine and alcohol. On 16 December 2018, American tech entrepreneur Colin Kroll, founder of social media video-sharing app Vine and quiz app HQ Trivia, died from an overdose of fentanyl, heroin, and cocaine. On 1 July 2019, American baseball player Tyler Skaggs died from pulmonary aspiration while under the influence of fentanyl, oxycodone, and alcohol. On 1 January 2020, American rapper, singer, and songwriter Lexii Alijai died from accidental toxicity resulting from the combination of alcohol and fentanyl. On 20 August 2020, American singer, songwriter and musician Justin Townes Earle died from an accidental overdose caused by cocaine laced with fentanyl. On 24 August 2020, Riley Gale, frontman for the Texas metal band Power Trip, died as a result of the toxic effects of fentanyl in a manner that was ruled accidental. On 22 April 2021, Digital Underground frontman, rapper, and musician Shock G died from an accidental overdose of fentanyl, meth, and alcohol. On 6 September 2021, actor Michael K. Williams, who rose to fame through his critically acclaimed role as Omar Little on the HBO drama series The Wire, died from an overdose of fentanyl, parafluorofentanyl, heroin, and cocaine.
In 2017 the death rate rose over 100% with 368 overdose-related deaths in British Columbia between January and April 2017.Fentanyl has started to make its way into heroin as well as illicitly manufactured opioids and benzodiazepines. Fentanyl contamination in cocaine, methamphetamine, ketamine, MDMA, and other drugs is common. A kilogram of heroin laced with fentanyl may sell for more than US$100,000, but the fentanyl itself may be produced far more cheaply, for about US$6,000 per kilogram. Fentanyl was often produced in China and exported illegally to the U.S. The UK illicit drug market is no longer reliant on China, as domestic fentanyl production is replacing imports.As of 2018, fentanyl was the most commonly listed opioid in overdose drug deaths, surpassing heroin. From 2013 until 2016, overdose deaths involving fentanyl were increasing by 113% per year. In 2021, the Public Health Agency of Canada noted that 87% of accidental apparent opioid toxicity deaths involved fentanyl.The intravenous dose causing 50% of opioid-naive experimental subjects to die (LD50) is "3 mg/kg in rats, 1 mg/kg in cats, 14 mg/kg in dogs, and 0.03 mg/kg in monkeys." The LD50 in mice has been given as 6.9 mg/kg by intravenous administration, 17.5 mg/kg intraperitoneally, 27.8 mg/kg by oral administration. The LD50 in humans is unknown, but its estimated that the lethal dose may be as low as 2 mg in some people depending on body size, tolerance, and past usage.