Research led by UCLA has highlighted an alarming 50-fold escalation in American overdose fatalities involving both fentanyl and stimulants since the year 2010. This marks an unsettling new phase, termed the ‘fourth wave,’ in the ongoing opioid crisis. The complex issue of polysubstance abuse presents novel challenges to healthcare systems, and has a disproportionate impact on racial minorities, along with distinct regional variations in drug compositions.
This ‘fourth wave’ is the latest in the evolution of the opioid overdose crisis in the United States. The crisis initially emerged with deaths from prescription opioids in the early 2000s and subsequently evolved to involve other types of drugs.
The UCLA study reveals that the percentage of American overdose deaths that involved both fentanyl and stimulants soared from 0.6% (235 fatalities) in the year 2010 to 32.3% (34,429 fatalities) in 2021.
By the year 2021, stimulants like cocaine and methamphetamine were the most frequently found category of drugs in overdose deaths involving fentanyl across all U.S. states. This alarming increase in fatalities involving fentanyl and stimulants forms the latest chapter, or ‘fourth wave,’ in America’s ongoing opioid epidemic, the casualty numbers of which continue to escalate at a rapid pace.
Table of Contents
Expert Opinions
Joseph Friedman, the principal investigator and an addiction research specialist at UCLA’s David Geffen School of Medicine, remarked, “The usage of fentanyl in conjunction with stimulants is swiftly becoming the predominant factor in the American overdose epidemic.”
He added, “Fentanyl is contributing to a crisis of polysubstance overdoses, which means that individuals are combining fentanyl not only with stimulants but also with various other synthetic substances. This presents a multitude of health risks and creates new challenges for healthcare professionals. While we have extensive medical knowledge on treating opioid disorders, we have comparatively less experience dealing with the complications arising from the mixture of opioids with stimulants or other synthetic drugs. This complexity further complicates medical stabilization of individuals undergoing withdrawal from multiple substances.”
The study was released on September 13 and has undergone peer review in the scientific journal Addiction.
Timeline of the Opioid Crisis
The research paints a detailed picture of the chronological development of the American opioid epidemic. Deaths initially involved commonly prescribed opioids in the early 2000s (first wave), followed by heroin in 2010 (second wave). The third wave was marked by an uptick in fentanyl overdoses around the year 2013. The current ‘fourth wave,’ involving fentanyl mixed with stimulants, commenced in 2015 and has been on a persistent upward trend.
Adding to the complexity, individuals using multiple substances are also at an elevated risk of experiencing overdoses, and many of the substances being combined with fentanyl do not respond to naloxone, which serves as the antidote for opioid overdoses.
Demographics and Geographic Trends
The research discovered that overdose deaths involving fentanyl and stimulants disproportionately affect racial and ethnic minorities in the United States, specifically within the Black and Native American communities. For instance, in 2021, 73% of the fentanyl overdose deaths among 65-74-year-old Non-Hispanic Black women in the western U.S., and 69% among 55-65-year-old Black men in the same region involved stimulants. This is in contrast to a 49% rate within the general American population in 2021.
Geographically, regional patterns were also observed. In the northeastern U.S., fentanyl is most frequently combined with cocaine, whereas in the southern and western U.S., methamphetamine is the prevalent accompaniment.
Joseph Friedman elaborated, “This regional variation likely reflects the increased availability of low-cost, high-purity methamphetamine across America, as well as the Northeast’s longstanding pattern of illicit cocaine use that has not yet been entirely supplanted by methamphetamine.”
The study was financed by the UCLA Medical Scientist Training Program and the National Institute on Drug Abuse at the National Institutes of Health. The content of the study solely represents the perspectives of the authors and is not necessarily aligned with the official stance of the National Institutes of Health.
Frequently Asked Questions (FAQs) about Fourth Wave in U.S. Opioid Crisis
What is the primary focus of the new UCLA research?
The primary focus of the UCLA-led research is to investigate the significant rise in U.S. overdose deaths involving both fentanyl and stimulants. The study identifies this trend as the ‘fourth wave’ in the ongoing opioid crisis.
What constitutes the ‘fourth wave’ in the opioid crisis according to the study?
The ‘fourth wave’ in the opioid crisis is characterized by a substantial increase in overdose deaths involving both fentanyl and stimulants like cocaine and methamphetamine. The percentage of such deaths has escalated from 0.6% in 2010 to 32.3% in 2021.
How are healthcare systems impacted by this ‘fourth wave’?
The fourth wave presents complex and novel healthcare challenges because it involves polysubstance abuse, meaning people are combining fentanyl with other drugs, including stimulants. This complicates medical stabilization and treatment protocols for individuals experiencing withdrawal from multiple substances.
Who is disproportionately affected by the fourth wave?
The study found that the fourth wave of the opioid crisis disproportionately impacts racial and ethnic minority communities, specifically Black and Native American populations.
Are there any regional patterns in drug combinations involved in the fourth wave?
Yes, the study identified distinct regional patterns. In the northeastern U.S., fentanyl is most commonly combined with cocaine, whereas in the southern and western U.S., it is more frequently combined with methamphetamine.
What is the antidote for opioid overdoses and does it work for the fourth wave?
The antidote for opioid overdoses is naloxone. However, the study notes that naloxone may not be effective in cases where multiple substances, including those not responsive to naloxone, are involved.
Who funded the UCLA research?
The study was financed by the UCLA Medical Scientist Training Program and the National Institute on Drug Abuse at the National Institutes of Health.
Where was the study published?
The findings of the study were published in the peer-reviewed scientific journal Addiction on September 13.
More about Fourth Wave in U.S. Opioid Crisis
- UCLA David Geffen School of Medicine
- National Institute on Drug Abuse
- Peer-Reviewed Journal Addiction
- CDC WONDER Database
- National Institutes of Health
- Information on Naloxone
- UCLA Medical Scientist Training Program
- Opioid Crisis Timeline
- Substance Abuse and Mental Health Services Administration
8 comments
why is this not making bigger headlines? people need to know this stuff, especially if naloxone isn’t working on these combos.
Scary stuff, honestly. And the racial disparities are so concerning. what’s the solution here?
This is getting way outta hand. Those researchers at UCLA must be equally shocked and concerned. Where do we go from here?
Always knew the opioid crisis was bad but this 4th wave is like a double whammy. Now people are mixin other stuff? Unbelievable.
Wow, these numbers are staggering. Didn’t know fentanyl was mixin’ with stimulants to this extent. Eye-opening.
If this is the 4th wave, I don’t wanna even think about a 5th. We’re losing too many people, too fast. What are we gonna do about it?
The regional variances are interesting. Like coke in the Northeast and meth in the South n’ West. Wonder what’s driving that pattern.
I gotta say, this 4th wave thing caught me off guard. We’ve been talking bout opioids for years, but this is a new beast. Healthcare’s got a huge problem on its hands.