A “fourth wave” crisis is claiming more lives than ever in America due to a combination of fentanyl with other drugs, researchers have found.
The US hit a grim milestone in 2021, with overdose deaths topping 100,000 for the first time. That figure is fuelled by the rise of the synthetic opioid with stimulants such as cocaine and methamphetamine.
Overdoses were once the result of heroin and prescription opioids, however synthetic opioids took over in the mid-2010s. Polysubstance overdoses – meaning multiple drugs – are the new challenge.
Overwhelmingly, the proportion of overdoses involving fentanyl and a stimulant rose more than fifty-fold from 2010 to 2021, according to a new study published in the journal Addiction.
“The fourth wave of the US overdose crisis (is) characterised by sharply rising polysubstance overdose deaths involving illicitly manufactured fentanyls,” the study’s authors wrote.
“Stimulant-fentanyl co-involvement is rapidly becoming the largest component of the crisis, with a distinct pattern seen by over time and by geography and sociodemographic groups.”
Chelsea Shover, an assistant professor-in-residence at the David Geffen School of Medicine at UCLA, co-authored the study and said that opioids started the problem but were now not the main issue.
“The roots really did start with overprescribing prescription opioids, but now it is really characterised by stimulants and fentanyl,” she told NBC News.
The team of researchers looked at death certificates from those who passed away from an overdose in the US between 2010 and 2021 to look at the drugs involved in the deaths, accessed from the US Centres for Disease Control. The data showed that 40,000 people died of a drug overdose across the country in 2010. Of those, just 7.2 per cent involved fentanyl. The deaths were mainly driven by heroin or prescription opioid use.
That’s compared to 2021, where 66 per cent of the 100,000 deaths were tied to fentanyl.
The study found that the stimulant that was combined with fentanyl changed depending on location. Almost all the deaths in the Northeast involved cocaine by 2021, while in the West and Midwest it was methamphetamine.
“It’s a moving target in the sense that the profile of what drugs or drug combinations are causing the most deaths has shifted every couple years in recent years,” Prof Shover said.
However, when fentanyl stared to become more widely used, it was devastating. Fentanyl is much more potent that heroin, and is a quick high.
”When fentanyl started to sweep the nation, it was ripe for combination,” Anna Childress, an adjunct professor of psychiatry at the University of Pennsylvania Perelman School of Medicine, who studies addiction medicine, said.
“The whole picture takes on a very dark tone,” Prof Childress said. “A little bit of fentanyl can easily kill someone who is primarily a stimulant user. Even people who are primary opioid users are dying left and right of fentanyl overdoses.”
Sean Blake died six years ago from an accidental overdose in Burlington, Vermont.
He was only 27 years old.
“Every time I hear of a loss to substance use, my heart breaks a little more,” his mother Kim Blake wrote in a blog dedicated to her son.
“Another family shattered. Forever grieving the loss of dreams and celebrations.”
She penned the heartbreaking words back in 2021, the year when 100,000 people were killed by drug overdoses – and 66 were linked to fentanyl.
The study pointed to the challenges this fourth wave is presenting.
“The widespread concurrent use of fentanyl and stimulants, as well as other polysubstance formulations, presents novel health risks and public health challenges.”
Experts such as Prof Shover said that treatment options just haven’t been able to keep up with the situation.
“Our treatment system for substance use disorder is often focused on one drug at a time,” Prof Shover said.
“But the reality is, many people who use drugs use more than one kind of drug.”
It comes after a warning fentanyl could “annihilate” Australian communities.
Since 2019, the Australian Federal Police has been instrumental in preventing 29 kilograms and an estimated 5.5 million lethal doses of fentanyl from hitting Australian streets.
However, AFP member and head of the Australian Federal Police Association, Alex Caruana, says the threat of such hauls slipping through the cracks is perilously real and it could be devastating.
“In places like Wagga and Dubbo where we can see what ice is doing to the organisation, we can see these pharmaceuticals are also a problem,” Mr Caruana said.
“If non-pharmaceutical fentanyl gets into those rural areas, it’s going to annihilate them. There’s already a scourge there with the ice, and it’s really going to make an impact.
“The cost to the Australian is going to be significant because we’re going to have to fork out money to prop up rural Australia.”
Originally published as ‘Fourth wave’ of crisis reaches every corner of the US