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Because NSDUH respondents were asked only about the misuse of prescription forms of fentanyl, estimates of fentanyl misuse for 2020 may underrepresent people who used illicitly manufactured fentanyl (IMF) from clandestine laboratories (i.e., as opposed to the misuse of diverted prescription fentanyl produced by the pharmaceutical industry) and may not include those who used IMF mixed with heroin or sold as heroin (but contained only IMF)

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