Overdose deaths caused by fentanyl-laced stimulants increased by 50 times between 2010 and 2021, according to new research from the University of California, Los Angeles.
Stimulants such as cocaine and methamphetamine can often be laced with the deadly opioid fentanyl, and by 2021, those drugs became the most common vehicle for fentanyl-related overdose deaths.
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In what study authors call the "fourth wave" of the opioid crisis, a staggering 34,429 Americans died from fentanyl-laced stimulant overdoses in 2021 compared to 235 in 2010 — an increase from 0.6% of all U.S. overdose deaths to 32.3%.
"Fentanyl has ushered in a polysubstance overdose crisis, meaning that people are mixing fentanyl with other drugs, like stimulants, but also countless other synthetic substances," lead author and UCLA researcher Joseph Friedman said. "This poses many health risks and new challenges for healthcare providers."
The study, published in Addiction, charted all four "waves" of the crisis, beginning with prescription opioid deaths in the early 2000s, followed by heroin in 2010, fentanyl itself by 2013, and, in 2015, fentanyl-laced stimulants. Once fentanyl came on the scene, overdose deaths skyrocketed, only to be surpassed by other drugs mixed with fentanyl.
Not only does the consumption of multiple drugs increase the risk of overdose on its own, but the mixture can also be less responsive to the opioid overdose reversal drug naloxone.
"We have data and medical expertise about treating opioid use disorders, but comparatively little experience with the combination of opioids and stimulants together, or opioids mixed with other drugs," Friedman said. "This makes it hard to stabilize people medically who are withdrawing from polysubstance use."
Researchers also found the common stimulant mixtures tend to be regional, with fentanyl-laced cocaine being more prominent in the Northeast, whereas laced methamphetamine is more prominent in the South and West.
"We suspect this pattern reflects the rising availability of, and preference for, low-cost, high-purity methamphetamine throughout the U.S., and the fact that the Northeast has a well-entrenched pattern of illicit cocaine use that has so far resisted the complete takeover by methamphetamine seen elsewhere in the country," Friedman said.
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Stimulants and opioids have often been used together to achieve an offsetting effect the National Institute on Drug Abuse calls "speedballing." The combination is also extremely dangerous because stimulants increase the body's need for oxygen while opioids decrease respiration.
Aside from the "speedballing" effect, some overdose deaths are caused by a user intending to ingest a stimulant and not knowing it was laced with fentanyl.