Home » America Facing ‘Fourth Wave’ of Opioid Epidemic, Fueled by Fentanyl and Meth

America Facing ‘Fourth Wave’ of Opioid Epidemic, Fueled by Fentanyl and Meth

by Richard A Reagan

The United States is confronting an unprecedented phase in its ongoing battle against opioid addiction, with a disturbing surge in polysubstance abuse marking the epidemic’s “fourth wave.” [Source]

A recent report by Millennium Health, based on analysis of over 4 million urine drug tests, unveils the complex dynamics of this new chapter, characterized by the simultaneous use of fentanyl and stimulants like methamphetamine and cocaine.

This “fourth wave” follows a grim trajectory that began with prescription opioids, transitioned to heroin, and then to synthetic opioids like fentanyl.

The current phase is particularly alarming due to the lethal combinations of drugs being consumed. Eric Dawson, vice president of clinical affairs at Millennium Health, voices a chilling observation: “And I’ve yet to see a peak,” signaling an ongoing crisis with no end in sight.

The report’s findings are staggering, revealing that nearly 93% of fentanyl-positive urine samples also contained other substances.

Nora Volkow, director of the National Institute on Drug Abuse, highlights the gravity of the situation, pointing out that “And that is huge.”

The increase in the concomitant use of meth and fentanyl is especially concerning, with a 875% spike in such cases since 2015, indicating a dramatic shift in drug use patterns.

The implications of these trends are profound, complicating the treatment of overdoses. While naloxone, an opioid overdose reversal medication, is widely available, there is no FDA-approved antidote for stimulant overdoses.

The presence of heroin and prescription opioids in fentanyl-positive samples has significantly decreased, a fact that Jarratt Pytell, an addiction medicine specialist, warns should not be seen as a positive development but rather as evidence of fentanyl’s dominance in the drug market.

Pytell also sheds light on the dangers posed by the ever-changing drug supply, where variability in potency and composition puts users at severe risk.

This volatility underscores the control drug suppliers have over the market, often dictating the availability and prevalence of certain drug combinations based on profitability and ease of production.

The report’s methodology, utilizing rapid urine sample analysis, offers a timely and accurate reflection of current drug use trends, a critical advantage over other data sources that often suffer from delays.

However, Jonathan Caulkins of Carnegie Mellon University’s Heinz College notes limitations, such as the inability to discern users’ intent or whether drugs were combined by choice or unknowingly.

With over 107,000 Americans lost to drug overdoses in 2021, the majority linked to fentanyl, the urgency to address this epidemic has never been greater. 

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