Families across the United States are facing an alarming escalation in the opioid crisis, as a “fourth wave” brings a surge of polysubstance use, primarily fentanyl mixed with methamphetamine or cocaine. This deadly combination challenges the fight against drug addiction and puts many Americans at an unprecedented risk.
According to a recent report by Millennium Health, there’s been a historical pattern of substance abuse starting with prescription opioids, progressing to heroin, and then moving to synthetic opioids like fentanyl. What’s especially dangerous now is the trend of using fentanyl alongside stimulants such as methamphetamine—a dangerous game that shows no signs of slowing down, reveals Eric Dawson, Millennium Health’s vice president of clinical affairs.
This “fourth wave” is evident in the staggering analysis of 4.1 million urine samples collected from individuals in drug addiction care from January 2013 to December 2023. Experts are deeply concerned about the nearly 93% prevalence of additional substances found with fentanyl, pointing to the commonality of polysubstance abuse. This is a “huge” issue, states Dr. Nora Volkow, the National Institute on Drug Abuse director.
The sharp spike in meth and fentanyl combinations is particularly troubling, marking an 875% increase in such cases since 2015. Meth, a highly addictive stimulant, poses severe health risks, yet its prevalence along with fentanyl highlights an alarming shift in drug consumption patterns. Even Volkow didn’t predict this dangerous turn.
While some data might suggest a decrease in heroin and prescription opioid use with fentanyl, Jarratt Pytell, an addiction specialist, cautions against misunderstanding these trends. A reduction doesn’t signal improvement; rather, it underscores the predominance of fentanyl, “the most dangerous opioids available,” as the drug supply shifts toward greater toxicity.
The report also reveals potential drivers of this terrifying trend. Drug suppliers, wielding considerable power over the market, are likely steering users towards methamphetamine and fentanyl because they’re simpler and more profitable to produce, Pytell notes. This shift to dangerous synthetic production sends a clear message: the drug epidemic is being fueled not by user preference, but by the disturbing economics of illicit drug trafficking.
Moreover, the urine sample analysis used for this report offers a more immediate picture of the crisis than other methods, which can be delayed by months. As Dawson articulates, these real-time insights are critical because relying on outdated data sources hampers our understanding of the current landscape in drug abuse and its deadly consequences.
Despite its strengths, the urine sample approach isn’t flawless. The intention behind substance use can remain ambiguous; there’s no certainty whether users are intentionally mixing drugs or unknowingly consuming combined substances. Understanding whether these drug use patterns vary across gender and age could help tailor effective interventions, indicating the need for further investigation, says Volkow.
While experts debate the complexities of drug use patterns, one truth remains undeniable: the crisis is taking lives at an alarming rate, with over 107,000 overdose deaths reported in 2021 predominantly due to fentanyl. Dawson somberly acknowledges the grim reality: America is losing far too many of its citizens to this epidemic.