The United States is sinking deeper into an opioid crisis. With some 120,000 overdose deaths predicted for 2023, the next wave seems likely to reach an unprecedented level. It's the "fourth wave," in fact, pointed out epidemiologist Chelsea Shover, from the University of California, Los Angeles (UCLA). In an article published on Thursday, September 14, with her colleague Joseph Friedman in the journal Addiction, she describes its distinct characteristics.
Forgive me for stating the obvious, but it comes after three other waves. The first developed in the late 1990s, fueled by the overprescription and misuse of legal opioids to treat pain. From 2010 onwards, we saw a significant increase in heroin overdose deaths among people previously dependent on opioid drugs. A few years later, around 2013, fentanyl began to take control of the illegal drug supply, with a further increase in the number of deaths across much of the US. Finally, in 2015, we began to observe that more and more deaths were occurring related to a combination of this synthetic opioid and other substances, mainly so-called stimulant drugs, cocaine and methamphetamine. What we are calling the fourth wave is unprecedented: In 2015, there were around 50,000 fatal overdoses. In 2022, the figures exceeded 110,000 deaths, and will probably be 120,000 in 2023.
By a massive increase in the prescription of opioids for pain relief. This practice began to spread in the 1990s and early 2000s, reaching its peak in the 2010s. As awareness grew, health authorities took steps to limit prescriptions. But it was too late, the addicted population was too large. Heroin market forces also came into play and consumption shifted.
For many users, the over-consumption of medicines was already based on illegal channels. They used painkillers bought by others: family, friends, but also people who resold them on the black market. Heroin was cheaper, and in some cases more available, as the conditions for issuing prescriptions had become stricter. The transition from one to the other, for people who were dependent and often desperate to satisfy their need for drugs, was fairly straightforward. As prescribing started to decrease, the supply of prescription opioids began drying up and heroin came in as a cheaper alternative, then fentanyl.
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