Opioids and stimulants create a lethal combination
Shutterstock / Thomas Andre Fure
Introduction
The US is experiencing a drastic surge in drug overdose deaths involving both fentanyl and stimulants. This alarming trend marks a new phase in the country’s ongoing opioid crisis, characterized by the simultaneous use of fentanyl and stimulant drugs.
Background
Since 1999, drug overdose deaths in the US have been steadily increasing. This rise is primarily attributed to the widespread use of prescription and illicit opioids such as oxycodone, heroin, and fentanyl.
Study Findings
Researchers, led by Chelsea Shover from the University of California, Los Angeles, collected data on overdose deaths between 2010 and 2021. They found that in 2021, nearly one-third of drug overdose deaths involved both fentanyl and a stimulant like cocaine or methamphetamine. This represents a 50-fold increase from 2010 when less than 1% of overdose deaths were attributed to this drug combination.
Furthermore, the study revealed that stimulant drugs were the most common substances involved in fentanyl-related overdose deaths across all US states by 2021. Previously, fentanyl-related deaths were more commonly associated with the use of prescription opioids, alcohol, and heroin.
The Fourth Wave
According to Shover, this surge in concurrent fentanyl and stimulant use signals a fourth wave in the US opioid epidemic. The initial waves involved prescription opioids in the early 2000s, followed by a shift to heroin in 2010, and the spread of illicit fentanyl a few years later. The current phase is characterized by the simultaneous use of fentanyl and stimulants.
Underlying Factors
Two primary factors contribute to this change. Firstly, individuals may use stimulants to counteract the sedative effects of opioids, particularly to protect themselves from potential harm or assault. Additionally, users report that the combination of fentanyl and stimulants delays opioid withdrawal symptoms and increases pleasurable sensations.
Secondly, drug dealers are intentionally adding illicit fentanyl to stimulant drugs. This practice boosts their profits since fentanyl is cheaper than cocaine and methamphetamine. However, this also increases the risk of overdose as individuals without opioid tolerance unknowingly consume fentanyl. Furthermore, the combination of fentanyl and stimulants is more lethal, especially since overdose-reversing medications like Narcan do not work against stimulants.
Prevention and Treatment
Preventing overdose deaths requires improving treatment options and access for both stimulant use disorders and opioid use disorders. Currently, only 40% of drug treatment facilities in the US offer medication-assisted treatment for opioid use disorder.
Nora Volkow, from the US National Institute on Drug Abuse, emphasizes the need to prioritize medications for methamphetamine use disorder and cocaine use disorder in addition to opioid use disorder. Failing to address these issues will hinder efforts to effectively combat the rising number of overdose deaths.
