Research from Denver Health’s Rocky Mountain Poison & Drug Safety (RMPDS) has introduced new approaches for estimating drug use, particularly focusing on illicitly manufactured fentanyl. The findings were published in JAMA Health Forum.
The study, titled “Proactive Bias Mitigation When Using Online Survey Panels for Self-Reported Use of Illicitly Manufactured Fentanyl,” reviewed survey data from over 175,000 adults in the United States collected between 2022 and 2024. Researchers examined self-reported fentanyl use and methods of administration.
By applying advanced bias correction techniques, the RMPDS team found that estimates of fentanyl use dropped by more than 70 percent. This result highlights the importance of addressing survey bias when relying on self-reported data.
“Accurate data is the foundation of effective public health action,” said Joshua Black, PhD, Senior Scientist of Statistical Research at RMPDS. “Our findings show that when we account for hidden sources of bias in online surveys, we get a clearer, more truthful picture of drug use in our communities. This helps ensure that prevention and treatment resources are directed where they’re truly needed.”
To achieve these results, RMPDS used several methods:
– Five validated detection techniques to identify and remove careless or inattentive responses
– Advanced calibration weighting to correct for both demographic and health-related factors — going beyond traditional statistical adjustments
The study found that after correcting for bias, self-reported fentanyl use rose slightly from 0.7% in 2022 to 1.1% in 2024. There was also an increase in oral consumption, which surpassed injection and smoking as the primary routes of use. The researchers noted that this shift toward oral use—which is less bioavailable—may help explain a decrease in mortality rates despite increased usage.
“When we use the right statistical tools, we get cleaner numbers that in turn provide insight we can act on,” Black said. “These corrected data reveal a shift toward oral fentanyl use, which carries different risks than injection or smoking. Understanding those patterns helps public health and clinical partners respond more precisely.”
The research underscores RMPDS’ position as a national leader in public health surveillance using reliable evidence to inform policy decisions and resource allocation.
The full article is available at JAMA Health Forum.
