America reaches troubling new phase of opioid epidemic, study says
Overdose deaths involving both fentanyl and stimulants higher than ever before detected
By: Sarah Hopkins
Dr. Chelsea Shover, an epidemiologist at UCLA who specializes in addiction research, had noticed an alarming new pattern in overdose deaths in Los Angeles before she decided to examine the data.
Using death records from 2010–2021, obtained from the Centers for Disease Control and Prevention, Shover created a graph that revealed a striking increase in overdose deaths involving both fentanyl and stimulants across the entire US. It confirmed that more people are dying from drug overdoses involving both fentanyl and stimulants, like methamphetamine and cocaine, than ever before detected.
Shover, co-author of a study examining this data, published September 2023 in the journal Addiction, found that overdose deaths involving fentanyl and stimulants have increased more than 50-fold since 2010 — from 235 deaths in 2010 to 34,429 deaths in 2021. By 2021, stimulants had become the most common drug type found in fentanyl overdoses in every US state.
The researchers observed stark patterns across geographical areas. Methamphetamine surfaced as the most common stimulant in fentanyl overdose deaths in Western states, while cocaine emerged as the dominant stimulant in fentanyl overdose deaths in the Northeast.
The data also revealed very high proportions of stimulant-fentanyl overdose deaths among older, Black populations living in the West, from 2016 to 2020. Black women between 65 and 74 years old accounted for 73.3% of those deaths; Black men between 55 and 65 years old accounted for 68.7%.
Researchers are calling this dramatic rise in stimulant-fentanyl overdose deaths the “fourth wave” of America’s opioid epidemic. It follows the rise in prescription opioid deaths in the late 1990s, and a wave of deaths from heroin about a decade later. Fentanyl entered the illicit drug market around 2013, setting off a third wave of overdose deaths that has far outpaced preceding waves in both speed and scale.
The biggest takeaway from the data, said Shover, is that we need access to sound treatments for stimulant-use disorder. “While we have good medications to treat and manage opioid addiction and overdose, for stimulants, it’s more complicated,” she said.
The most effective treatment to date for stimulant use disorder — a behavioral therapy where people are given a small monetary reward every time their drug test comes back negative — has proven a hard sell politically.
Jeanine Buchanich, a biostatistician at the University of Pittsburgh School of Public Heath who was not involved in the research, said that the study points toward a crucial area for further research: knowing how people are mixing substances. Whether they are taking them simultaneously or not, “could help us to develop harm reduction plans and policies,” she said.
Dr. Sarah Clingan, an addiction researcher at UCLA who was not involved with the study, also pointed toward the importance of harm reduction strategies as a response to the opioid crisis. She hopes that policymakers will take a closer look at those strategies to create novel public health responses.
“In the United States we need to recognize that what we’ve been doing to address these issues has not been working. It’s only getting worse,” said Clingan. “We’re losing a generation.”
