Fentanyl and Methamphetamine: A Deadly Combination Fueling Overdose Deaths in the US
Illicit fentanyl, the driving force behind the U.S. overdose epidemic, is increasingly being used in conjunction with methamphetamine, a new report shows. According to Millennium Health, 60% of patients whose urine samples contained fentanyl last year also tested positive for methamphetamine, while cocaine was detected in 22% of the fentanyl-positive samples.
The report by Millennium Health highlights the impact of what they call the “fourth wave” of the nation’s overdose epidemic. This wave began over a decade ago with the misuse of prescription opioids, followed by a heroin crisis, and most recently, an increase in the use of illicit fentanyl. The study found that people battling addiction are increasingly using illicit fentanyl along with other substances, including stimulants such as methamphetamine and cocaine.
Interestingly, the report suggests that both heroin and prescription opioids are being abused less often than they were a decade ago. Of the urine samples containing fentanyl analyzed in the report, 17% also contained heroin, and 7% showed the presence of prescription opioids.
The Millennium report is based on analyses of urine samples collected from more than 4.1 million patients in 50 states between January 1, 2013, and December 15, 2023. These samples were collected in doctors’ offices and clinics that see patients for pain, addiction, and behavioral health treatment. Shockingly, 93% of fentanyl samples tested positive for at least one other substance, a concerning finding according to Dr. Nora Volkow, director of the National Institute on Drug Abuse.
Overdose deaths in the United States have been climbing steadily. In 2021, overdose deaths surpassed 100,000 and continued to increase in 2022. Provisional data from the Centers for Disease Control and Prevention showed that overdose deaths through September 2023 increased by about 2% compared to the previous year.
Another alarming trend highlighted in the report is the involvement of stimulants, particularly methamphetamine, in fentanyl overdoses. In 2021, stimulants were detected in about 1 in 3 fentanyl overdose deaths, compared to just 1 in 100 in 2010.
Eric Dawson, vice president of clinical affairs at Millennium Health, expressed concern over the finding of methamphetamine in so many samples. He stated that methamphetamine is more potent, more pure, and probably cheaper than ever before in the country. The flooding of communities with dangerous methamphetamine poses a significant threat to public health.
What makes the situation even more challenging is that there are no approved medications by the Food and Drug Administration for overdoses involving stimulants like methamphetamine. While naloxone and similar drugs can counteract opioid overdoses, there are no equivalent treatments for stimulant-use disorder. This deficit in effective treatments for methamphetamine addiction is a glaring issue that needs to be addressed urgently.
The Millennium report also found regional differences in drug use. Methamphetamine samples were detected more frequently in the western U.S., particularly in the Pacific and Mountain West states. On the other hand, cocaine appeared to be more prevalent in the Eastern U.S., with over 54% of fentanyl-positive samples in New England also testing positive for cocaine.
Other findings from the report include a surge of 318% in the presence of cocaine samples in fentanyl-positive specimens from 2013 to 2023. The presence of heroin in fentanyl-positive specimens dropped by 75% following a peak in 2016, and the presence of prescription opioids hit an all-time low in 2023, indicating a shift away from pain medications in the U.S. addiction crisis.
Dr. Nora Volkow emphasized the importance of reports like Millennium Health’s, as they provide researchers with a snapshot of the nation’s evolving drug use. These reports offer more timely data than death investigations from overdoses can provide, helping public health officials better understand and address the complex issue of polysubstance abuse and the rising number of overdose deaths in the country.
The findings of this report serve as a stark reminder of the urgent need for comprehensive strategies to combat the overdose epidemic in the United States. Addressing the deadly combination of fentanyl and methamphetamine requires a multi-faceted approach that includes prevention, education, access to treatment, and the development of effective medications for stimulant-use disorder. Only through a concerted effort can we hope to save lives and turn the tide on this devastating crisis.
