News Releases

U.S. Hit by “Fourth Wave” of Opioid Crisis with Rise of Polysubstance Overdoses

Researchers at the David Geffen School of Medicine at The University of California, Los Angeles (UCLA) recently published a study in the monthly journal Addiction that finds the proportion of U.S. overdose deaths involving both fentanyl and stimulants has increased more than 50-fold since 2010, leading to what has been called the “fourth wave” of the opioid crisis.

Researchers discovered that of all the overdose deaths in the U.S. in 2010, only half a percent of fentanyl overdose deaths — 235 people — included stimulants. That number drastically increased in 2021 to nearly one-third of all fentanyl overdose deaths including stimulants — more than 34,000 people.

According to the data, the fourth wave began to form in 2015 when there was an increase in overdoses involving stimulants in nearly every state. The stimulant found to be combined with fentanyl varied based on location. While most of these overdoses in the northeast United States involved cocaine, the southern and western parts of the country saw a rise in fentanyl mixed with methamphetamine.

Challenges Posed by Polysubstance Use

Presenting new complexities for healthcare workers, this fourth wave is a significant challenge as many workers have less experience with treating the combination of opioids and stimulants.

Narcan nasal spray — now available over the counter — can reverse an opioid overdose and methadone and buprenorphine can treat opioid use disorder, but there are currently no drugs available to specifically treat stimulant overdoses. Stimulants and opioids have opposite effects on the body, which is what may cause people to use one to counteract the other.

Emergence of Xylazine

Earlier this year, health officials warned of a new worrying combination — fentanyl laced with the animal tranquilizer xylazine. The Centers for Disease Control and Prevention released data that showed the percentage of fatal opioid overdoses in which xylazine was detected increased by 276% between Jan. 2019 and June 2022.

In April, the Biden-Harris administration used executive designation authority to declare fentanyl combined with xylazine as an emerging threat to the U.S. Also known as tranq, xylazine can put people into a state of unconsciousness for hours, slowing their heart rate and lowering blood pressure. Regardless of the drug being smoked, snorted, or injected, continued use of xylazine can cause disfiguring wounds, typically on a person’s legs or arms.

Multi-Pronged Solutions

The administration’s National Response Plan to the opioid crisis includes short- and long-term action steps to provide immediate relief to communities across the nation and to support the efforts needed to end the epidemic and the growing threat of polysubstance use. Organizations like The Center for Health Affairs are creating opportunities to shine a light on the medical stigma surrounding addiction while sharing stories of treatment, including psychosocial intervention to address the complexities that fentanyl brings to treating substance use disorders.

The Center recently released its documentary, Igniting Compassion, which offered a look into the lives of Northeast Ohio residents impacted by the opioid crisis and polysubstance use and the clinicians who care for them.