US Overdose Crisis in ‘Fourth Wave’ With More Deaths Caused By Mixing Fentanyl With Stimulants, Study Says



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Overdose deaths in the United States increasingly involve both fentanyl, an opioid, and a stimulant such as methamphetamine or cocaine, according to researchers who say the trend marks the “fourth wave” of the country’s overdose crisis.
According to new research led by UCLA, the proportion of U.S. overdose deaths involving both fentanyl and stimulants increased from 0.6% in 2010 to 32.3% in 2021, accounting for 34,429 deaths that year. By 2021, stimulants including cocaine and methamphetamine became the most common drug class found in fentanyl-involved overdoes in every state, researchers said.
Their study was published Wednesday in the journal Addiction.
“We’re now seeing that the use of fentanyl together with stimulants is rapidly becoming the dominant force in the U.S. overdose crisis,” lead author Joseph Friedman, an addiction researcher at the David Geffen School of Medicine at UCLA, said in a statement.
“Fentanyl has ushered in a polysubstance overdose crisis, meaning that people are mixing fentanyl with other drugs, like stimulants, but also countless other synthetic substances. This poses many health risks and new challenges for healthcare providers,” Friedman said.
“We have data and medical expertise about treating opioid use disorders, but comparatively little experience with the combination of opioids and stimulants together, or opioids mixed with other drugs. This makes it hard to stabilize people medically who are withdrawing from polysubstance use,” Friedman said.
This “polysubstance” crisis marks the “fourth wave” of the overdose crisis in the U.S., according to researchers. The first wave began in the early 2000s with an increase in deaths caused by prescription opioids. As it gradually became more difficult to obtain prescription opioids, overdose deaths shifted to heroin for wave two around 2010. Wave three, marked by the rise of fentanyl, began around 2013.
The fourth wave, involving polysubstance overdose deaths, began around 2015, and continues to grow, researchers said.
“Due to decades of overprescribing, most misused opioids come from friends’ and family’s medicine cabinets. Since access is easier than to alcohol, young people are used to experimenting with them. Now that fake fentanyl-laced pills look like leftover Oxycontin, the consequences are deadly, not just dependency,” said Amy Baxter, CEO and Chief Medical Officer of Pain Care Labs.
The use of multiple drug classes simultaneously complicates efforts to treat overdoses. Naloxone, sold under the brand name Narcan, reverses opioid overdoses, but has no effect on other types of substances.
Researchers found that polysubstance overdose deaths disproportionately affect older members of racial and ethnic minorities.
In 2021, the prevalence of stimulant involvement in fentanyl overdose deaths was 73% among 65 to 74-year-old Non-Hispanic Black or African American women and 69% among 55 to 65-year-old Black or African American men living in living in the western U.S. The rate among the general U.S. population was 49%.
There are also geographical differences in which stimulants are involved in polysubstance overdose deaths across the U.S. In the northeast, cocaine is more common, while methamphetamine is more common in the western and southern U.S.
“We suspect this pattern reflects the rising availability of, and preference for, low-cost, high-purity methamphetamine throughout the U.S., and the fact that the Northeast has a well-entrenched pattern of illicit cocaine use that has so far resisted the complete takeover by methamphetamine seen elsewhere in the country,” Friedman said.
“This is about addiction, but the root cause comes back to the state of mental health today. So many people are suffering from depression and anxiety,” said executive and life strategist Rob Swymer, author of “Surrender to Your Adversity: How to Conquer Adversity, Build Resilience and Move Toward Your Life’s Purpose.”
“According the most recent report by the National Alliance on Mental Illness, 1 in 5 adults suffer from depression, 50% of all lifetime mental illness begins by age 14, and 75% by age 24. Suicide is the second leading cause of death among people aged 10–14,” Swymer said.
“We have to normalize the discussion around addiction and mental health. It is ‘OK not to be OK’. By increasing services in communities and schools, we can provide more education and awareness focused on our younger generation and maybe, just maybe, we can start to see some progress here,” Swymer said.
TMX contributed to this article.