Overdose deaths caused by fentanyl mixed with other drugs

The surge in drug overdose deaths this year and last has sparked concern among many researchers, doctors and health officials about drug abuse and addiction, as well as a growing trend among overdose victims which seems to indicate a new and different wave of the opioid epidemic.

While the loneliness and challenges of the coronavirus pandemic appear to have led to drug use, many experts say the latest wave of overdoses is due in part to the use of fentanyl with other drugs.

Overdose deaths have reached new highs in the United States – more than 100,000 deaths this year, according to the Centers for Disease Control and Prevention – but experts say this is part of a fourth wave of the overdose epidemic , in which an increasing number of drug addicts die with multiple substances in their systems.

Behind that 100,000 figure, they said, there is a continued rise in the number of deaths related to cocaine, methamphetamine and other drugs that are linked to the simultaneous use of fentanyl.

“Probably more than half of the cases involve fentanyl mixed with another drug,” said Dr. Robert Anderson, chief of mortality statistics at the CDC’s National Center for Health Statistics.

The co-use of fentanyl and other drugs sets this wave apart from those that preceded it, characterized by the increasing use of prescription pain relievers and then the rise of heroin and fentanyl individually.

“I’m actually not talking about an opioid epidemic,” said Dr. James Berry, director of addiction services and chair of the department of behavioral medicine at the University of West Virginia. “I call it an addiction epidemic, because the substance varies, and there is usually more than one substance used.

Although the trend has been identified, its cause is not yet definitive: are drug users knowingly consuming fentanyl and other drugs, or is fentanyl entering the larger drug supply via resellers and distributors?

“It could really happen at any point and at multiple points in the drug supply chain,” said Kelly Dougherty, Vermont assistant health commissioner for substance abuse programs. . “Some people want to use fentanyl, despite the dangers, and some people use it without knowing it – it’s scary. People cut it, and that basically makes it deadlier. “

As Vermont works to make fentanyl test strips more accessible so users can check their drugs for contamination, Dougherty said users should more often assume that any illicit drugs they buy can. contain fentanyl.

The Biden administration announced this year that state and local governments can use federal funds to purchase fentanyl test strips in the hope of stemming the surge in overdose deaths.

But many experts believe that fentanyl is part of the increased drug supply at the distributor level. Distributors or dealers appear to either cut other drugs with fentanyl, as it is particularly cheap and has a strong effect, or contaminate their other drugs by accident using dirty work surfaces, gloves and tools.

“There are cases where patients will use both cocaine and fentanyl on purpose,” said Berry, who cited some of his interactions with patients, “but that’s largely the fact that almost everything you can think of is being cut with fentanyl on the streets these days.

Other than anecdotes and assumptions, however, there is little specific data on why a growing number of overdose victims have multiple drugs in their system when they die.

Dr Daniel Ciccarone, a drug addiction researcher at the University of California at San Francisco, said it remains unclear whether most overdoses are caused by the intentional co-use of fentanyl with other drugs or if contamination or tampering occurs at the dealer. He said the real reason remains in a “black box” that must be unboxed with further research.

“I think the contamination hypothesis is overblown and based on fear,” said Ciccarone, who posted on the fourth wave of overdoses and is working on a study into the reasons for the latest trend. “There is evidence across the country – a few papers that have been published, but also data from my research in places like West Virginia – that shows the combined use of methamphetamine or a strong stimulant with a potent opioid is a popular combination now.

“It is an important and growing phenomenon,” he added. “This is a question we should not ignore. “

Unfortunately, the problem has many heads.

Brendan Saloner, a professor at the Johns Hopkins School of Public Health who studies drug addiction and treatment, said fentanyl was starting to move across the country and was affecting communities that had not had to deal with the epidemic of opioids in the past.

“It looks like what’s going on is that a lot of the overdose risk has just moved to areas of the country that didn’t really have that much sensitivity before, so I think it’s taking a lot of people. by surprise right now, ”Saloner said. . “Certainly some places, especially west of the Mississippi, looks like it’s getting worse really fast.”

Beyond that, Saloner said, state and local governments must work to rebuild drug treatment and awareness systems that were left unattended during the pandemic. Addiction services, he said, should be the main focus of efforts at this time.

He said the United States also needs to expand the number of people it provides with these services and work in areas that lack the resources to tackle the opioid epidemic.

“Environments like hospital emergency departments, where most people cannot seek treatment, or prisons and prisons require more attention,” he said. “There are a lot of crisis systems out there that just aren’t helping people very well right now.”

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