Over the past decade, there has been a significant rise in the proportion of drug overdose deaths in the US that involve both fentanyl and stimulants. This surge in concurrent use represents a new phase in the country’s ongoing opioid crisis.
Since 1999, drug overdose deaths in the US have been steadily increasing, largely due to the spread of prescription and illicit opioids such as oxycodone, heroin, and, more recently, fentanyl.
To gain insights into trends in fentanyl use, a team led by Chelsea Shover at the University of California, Los Angeles, collected data on overdose deaths between 2010 and 2021 from the US Centers for Disease Control and Prevention’s WONDER database. The researchers found that in 2021, almost a third of drug overdose deaths involved both fentanyl and a stimulant such as cocaine or methamphetamine. This represents a 50-fold increase from 2010, when less than 1 per cent of overdose deaths were attributed to this drug combination. Additionally, stimulants were found to be the most common drugs involved in fentanyl-related overdose deaths in every US state by 2021. In the past, overdose deaths involving fentanyl typically occurred alongside prescription opioids, alcohol, or heroin.
This shift in the drug combination signals a fourth wave in the US opioid epidemic. Previously, the epidemic saw waves of deaths from prescription opioids, followed by heroin use and the emergence of illicit fentanyl. Now, the crisis has entered a new phase characterized by simultaneous use of fentanyl and stimulants.
There are two factors underlying this change. First, some individuals may be using stimulants to counteract the sedative effects of opioids, as sedation can make them more vulnerable to robbery or assault, particularly if they are experiencing homelessness. In addition, the combination of these drugs reportedly delays opioid withdrawal symptoms and increases euphoria.
The second factor is the deliberate addition of illicit fentanyl to stimulants by drug dealers. This not only increases their profits due to the lower cost of fentanyl compared to cocaine and methamphetamine but also raises the risk of overdose, as people without opioid tolerance may unknowingly consume fentanyl. Moreover, the combination of fentanyl and stimulants is more lethal, especially since overdose-reversing medications like Narcan do not work against stimulants.
To address these findings, experts emphasize the importance of improving treatment options and access to medication-assisted treatment for both stimulant use disorders and opioid use disorders. Currently, many drug treatment facilities in the US do not offer medication-assisted treatment, which is considered the gold standard for opioid use disorder. Prioritizing the development and availability of medications for methamphetamine and cocaine use disorders is necessary to effectively combat the rising number of overdose deaths seen today.
