Sharp Increase in US Overdose Deaths from Fentanyl-Stimulant Combinations

The number of drug overdose deaths in the US involving a combination of fentanyl and stimulants has increased significantly in recent years. This marks a new phase in the country’s opioid crisis, as it is now characterized by concurrent fentanyl and stimulant use.

Since 1999, drug overdose deaths in the US have been steadily rising, mainly due to the proliferation of prescription and illicit opioids such as oxycodone, heroin, and more recently, fentanyl.

To better understand the trends in fentanyl use, researchers 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 analysis revealed 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 percent 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, replacing the previous trend of fentanyl being associated with prescription opioids, alcohol, and heroin.

This shift in drug combinations signals a new phase of the US opioid epidemic, referred to as the fourth wave. The first wave began around 2000 with the rise of deaths from prescription opioids, followed by a shift towards heroin use in 2010 as the second wave. The third wave emerged a few years later with the widespread availability of illicit fentanyl. Now, the crisis has entered a new phase characterized by simultaneous fentanyl and stimulant use.

There are two likely factors contributing to this change. First, some individuals may be using stimulants to counteract the sedative effects of opioids, as sedation can leave them more vulnerable to robbery or assault, especially if they are experiencing homelessness. Furthermore, users report that the combination of opioids and stimulants delays withdrawal symptoms and enhances euphoria.

The second factor is deliberate adulteration of stimulants sold by drug dealers with illicit fentanyl. This increases profits for dealers because fentanyl is cheaper than cocaine and methamphetamine. However, it also raises the risk of overdose, as people without opioid tolerance may unknowingly consume fentanyl. Additionally, this combination is more lethal, particularly since overdose-reversing medications, like Narcan, do not work against stimulant overdoses.

To address this evolving crisis, experts emphasize the need to improve options and access to treatment for both stimulant use disorders and opioid use disorders. Currently, only 40 percent of drug treatment facilities in the US offer medication-assisted treatment, which is considered the gold standard for opioid use disorder. Prioritizing the development of medications for methamphetamine and cocaine use disorders is essential to effectively reduce the current overdose death rates.