Huge rise in US overdose deaths from fentanyl mixed with stimulants

The proportion of drug overdose deaths within the US involving each fentanyl and stimulants elevated greater than 50-fold between 2010 and 2021. This surge represents a brand new part within the nation’s worsening opioid disaster, one characterised by concurrent fentanyl and stimulant use.

Since 1999, drug overdose deaths within the US have steadily risen, primarily because of the unfold of prescription and illicit opioids like oxycodone, heroin and, extra just lately, fentanyl.

To higher perceive developments in fentanyl use, Chelsea Shover on the University of California, Los Angeles, and her colleagues collected knowledge on overdose deaths between 2010 and 2021 utilizing the US Centers for Disease Control and Prevention’s WONDER database. This database tracks all recorded fatalities within the nation together with the place, when and the way they occurred.

The researchers discovered that in 2021, nearly a 3rd of drug overdose deaths concerned each fentanyl and a stimulant like cocaine or methamphetamine. That is a 50-fold improve from 2010 when lower than 1 per cent of overdose deaths have been attributed to the drug mixture. They additionally discovered that by 2021, stimulants have been the most typical medicine concerned in fentanyl-related overdose deaths in each US state. Previously, overdose deaths involving fentanyl often occurred alongside prescription opioids, alcohol and heroin.

“Most of the US, especially the western US, is now dominated by [concurrent] meth and fentanyl use,” says Shover. “In the eastern US, it is more common to see cocaine co-involved with fentanyl.”

This alerts a fourth wave within the US opioid epidemic, she says. The first wave started round 2000 with the rise of deaths from prescription opioids. The second occurred in 2010 with a shift in direction of heroin use and the third began a number of years later as illicit provides of fentanyl unfold throughout the nation. Now, the disaster has entered a brand new part distinguished by simultaneous fentanyl and stimulant use.

Two elements in all probability underlie this variation. First, individuals could also be utilizing stimulants to counteract the opioid’s sedative impact as a result of sedation can go away them extra susceptible to theft or assault, particularly if they’re experiencing homelessness, says Nora Volkow on the US National Institute on Drug Abuse in Maryland. Some customers additionally report that the mixture delays opioid withdrawal signs and will increase euphoria.

The second issue is that drug sellers are intentionally including illicit stimulants to the fentanyl they promote. This boosts their earnings as a result of fentanyl is cheaper than cocaine and methamphetamine, but in addition will increase the danger of overdose as individuals with out opioid tolerance are inadvertently consuming fentanyl, says Volkow. Plus, the mixture is extra deadly, particularly since overdose-reversing drugs, like Narcan, don’t work towards stimulants, she says.

“I think the implication [of these findings] in terms of preventing overdose is really working on improving options and access to treatment for stimulant use disorders as well as opioid use disorders,” says Shover. For occasion, solely 40 per cent of drug therapy amenities within the US in 2017 supplied medication-assisted therapy – the gold normal for opioid use dysfunction.

“We have been prioritising the pipeline for medications for opioid use disorder, and now we are realising that we need to prioritise the medications for methamphetamine use disorder and cocaine use disorder too,” says Volkow. “Without doing that, we will not be able to effectively counteract the overdose deaths that we’re currently observing.”