Experts have identified the United States as currently experiencing a “fourth wave” of opioid overdose deaths. This wave is characterized by a significant increase in the presence of fentanyl, a synthetic opioid, mixed with stimulant drugs. A study conducted by UCLA and published in the journal Addiction found that the percentage of overdoses involving a combination of fentanyl and stimulants increased by more than 50-fold between 2010 and 2015. Lead author Joseph Friedman, an addiction researcher at UCLA, stated that the use of fentanyl with stimulants is rapidly becoming the dominant factor in the U.S. overdose crisis. Fusion of fentanyl with stimulants has led to a polysubstance overdose crisis, with individuals combining fentanyl with a variety of other drugs, including stimulants and synthetic substances. Previous waves of opioid overdose deaths occurred in the early 2000s, when prescription opioids rose in popularity, in 2010 when heroin was commonly mixed with fentanyl, and in 2013 when fentanyl alone was used. The current fourth wave began in 2015 with the widespread use of fentanyl mixed with stimulants. The study also showed that fentanyl was primarily found in stimulants such as cocaine and methamphetamine by 2021. Overdose death rates involving fentanyl-stimulant combinations increased drastically between 2015 and 2021 in nearly every state. Certain racial groups, particularly Black or African American women in western states and Black or African American men aged 55 to 65 in the same regions, experienced the highest rates of fentanyl-stimulant overdose deaths. Dr. Adam Scioli, medical director at Caron Treatment Centers in Philadelphia, stated that polysubstance use has become the norm in recent years. The combination of fentanyl and stimulants carries significant risks, including stroke or death. Dr. David Campbell, clinical director of The Canyon Addiction Treatment Center in Santa Monica, California, has observed a substantial rise in the combined use of stimulants and opioids. Dr. Scioli emphasized the importance of having Narcan, an overdose-reversing drug, accessible in case of an overdose. Synthetic opioids like fentanyl were involved in over 75% of overdose deaths, and many blended substances do not respond to naloxone, an opioid overdose antidote. Dr. Lawrence Weinstein, chief medical officer of American Addiction Centers, warned that the situation may worsen and that a concerted effort is necessary to address the opioid crisis. Yearly overdose deaths in the U.S. exceeded 100,000 for the first time in 2021.
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