More ODs involve opioids, stimulants
Use of both adds to effect, experts say
The evolving overdose crisis in the United States is making another lethal turn, federal disease trackers reported Wednesday: Increasingly, people dying from opioids are also using stimulants such as cocaine and methamphetamine.
An analysis by the Centers for Disease Control and Prevention shows that between 2011 and 2021, the age-adjusted rate of overdose deaths involving opioids and cocaine nearly quintupled, far outpacing the rate of deaths involving only cocaine. In 2021 alone, nearly 80% of the 24,486 cocaine overdose deaths recorded in the United States also involved an opioid.
Experts say it represents the latest wave of the nation’s drug epidemic. For many users injecting or smoking fentanyl for some time, “adding a stimulant makes the drug feel like it did in the beginning,” said Daniel Ciccarone, a professor of addiction medicine at the University of California at San Francisco, who has been studying the simultaneous use of stimulants and opioids.
The federal analysis adds clarity to the staggering number of drug poisonings, largely driven by fentanyl, which can be up to 50 times more powerful than heroin. The CDC estimates that in 2022, more than 110,000 people succumbed to overdoses, edging past the previous year but representing a plateau from earlier spikes. Preliminary CDC data also suggest a slight increase in deaths in 2022 involving opioids taken with cocaine and psychostimulants such as meth.
“These aren’t mutually exclusive categories. Someone can die of more than one drug,” said CDC researcher Merianne Rose Spencer, who led the analysis.
The international cocaine market has thrived despite shutdowns associated with the coronavirus pandemic, according to the U.N.’s Global Report on Cocaine 2023, with record production in Latin America, new trafficking hubs in Africa and increased seizures.
Across the United States, headlines abound with cases of people dying after unwittingly consuming cocaine laced with fentanyl: six people dead from a contaminated batch in Long Island in 2021, five dead inside a Colorado apartment last year and seven over several days in Kalamazoo, Mich., in April. But while contaminated cocaine — whether it is done accidentally or intentionally by dealers — is a real concern;f researchers who study the illicit drug market say they believe most deaths involve users knowingly consuming the drug alongside fentanyl.
And in a recent survey of more than 500 drug users in North Carolina and West Virginia, the overwhelming number reported intentionally using fentanyl with meth, said Jon E. Zibbell, a senior scientist at the nonprofit research institute RTI International. They reported using the drug to counteract the powerful sedation of fentanyl, he said.
“Fentanyl is so sedative that people are having a hard time staying awake,” Zibbell said. “So people are using stimulants alongside fentanyl just to be able to do life.”
Zibbell stressed that fentanyl is the agent chiefly complicit in causing deaths, noting that while cocaine and meth can contribute to stimulant use disorder, “these illicit stimulants just aren’t as big purveyors of death compared with illicit fentanyl, not even close.”
Mixing stimulants with downers is hardly new. Decades ago, users took cocaine-and-heroin combinations known as “speedballs.” Today, the mixes of meth and fentanyl are sometimes called “goofballs.”
Officials say Mexican organized crime has increasingly pumped cheap, high-grade meth into the United States, along with fentanyl. Meth is a long-acting stimulant that heightens alertness, euphoria and energy and can increase blood pressure and heart and respiratory rates. It is a psychostimulant, in the same category as prescription drugs such as amphetamines and methylphenidate, which is used to treat attention-deficit/hyperactivity disorder.
In 2017, the rate of deaths involving cocaine and other psychostimulants alongside opioids surpassed the rate of deaths from psychostimulants alone, the CDC analysis showed. By 2021, the rate stood at 6.7 deaths per 100,000 people, up from 0.3 a decade earlier. Overall in 2021, there were 21,371 overdose deaths involving both psychostimulants and opioids in the United States, with the highest rates in the Northeast.
In the West, meth has long been a drug of concern, and it became deadlier as fentanyl infiltrated drug supplies. In 2008, when 83 people died from meth in the state of Washington, fewer than one-third of cases involved an opioid, according to the Addictions, Drug & Alcohol Institute at the University of Washington. By 2021, meth deaths numbered 1,239 — and more than half involved opioids.