The United States is currently grappling with what some experts identify as the "fourth wave" of the opioid epidemic, presenting increased risks for drug users and complicating efforts to tackle the nation's drug crisis.
This wave progression began with a crisis in prescription opioid use, followed by a surge in heroin consumption, and subsequently, a rise in the use of synthetic opioids like fentanyl. The most recent wave involves the concurrent use of multiple substances, primarily combining fentanyl with either methamphetamine or cocaine, according to a comprehensive report. One of the co-authors, also the vice president of clinical affairs at Millennium Health, emphasized the absence of a discernible peak in this disturbing trend.
The report, based on 4.1 million urine samples collected between January 2013 and December 2023 from individuals undergoing drug addiction care, revealed alarming statistics. The primary finding highlighted the prevalence of polysubstance use, with nearly 93% of fentanyl-positive urine samples containing additional substances.
Of particular concern is the significant uptick in the combination of methamphetamine and fentanyl. Methamphetamine, a highly addictive substance often in powder form with severe cardiovascular and psychiatric risks, was present in 60% of fentanyl-positive tests in the past year—a staggering 875% increase since 2015.
Additional key findings from the report include a nationwide spike in methamphetamine use alongside fentanyl, altering established drug use patterns. The complexity of polydrug use trends poses challenges for overdose treatments, given that there isn't an FDA-approved medication for stimulant overdose, despite the widespread availability of naloxone, an opioid-overdose reversal medication.
Moreover, the report indicates a decline in both heroin and prescribed opioid use alongside fentanyl. Heroin detected in fentanyl-positive tests has decreased by 75% since its peak in 2016, while prescription opioids were found at historically low rates in fentanyl-positive tests in 2023—a notable 89% decrease since 2013.
