Why fentanyl is the leading cause of overdose deaths in the US
Over 150 Americans die every day from overdoses related to fentanyl and synthetic opioids. Here’s why fentanyl is so deadly.
Just the FAQs, USA TODAY
Illicit fentanyl, the driving force behind the U.S. overdose epidemic, is increasingly being used in conjunction with methamphetamine, a new report shows.
The laboratory Millennium Health said 60% of patients whose urine samples contained fentanyl last year also tested positive for methamphetamine. Cocaine was detected in 22% of the fentanyl-positive samples.
Millennium officials said the report represents the impact of the “fourth wave” of the nation’s overdose epidemic, which began over a decade ago with the misuse of prescription opioids, then came a heroin crisis and more 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.
The report suggests 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 from Jan. 1, 2013, to Dec. 15, 2023. The samples were collected in doctors’ offices and clinics that see patients for pain, addiction and behavioral health treatment.
Overall, 93% of fentanyl samples tested positive for at least one other substance, a concerning finding, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.
“I did not expect that number to be so high,” she said.
Overdose deaths climb
Drug overdose deaths in the United States surged past 100,000 in 2021 and increased again in 2022. Provisional data from the Centers for Disease Control and Prevention showed overdose deaths through September 2023 increased about 2% compared with the year before.
Other reports show that stimulants, mostly methamphetamine, are increasingly involved in fentanyl overdoses. In 2021, stimulants were detected in about 1 in 3 fentanyl overdose deaths, compared with just 1 in 100 in 2010.
The finding of methamphetamine in so many samples is especially concerning, said Eric Dawson, vice president of clinical affairs Millennium Health.
“Methamphetamine is more potent, more pure and probably cheaper than it’s ever been at any time in this country,” Dawson said. “The methamphetamine product that is flooding all of our communities is as dangerous as it’s ever been.”
Methamphetamine has no rescue drugs, treatments
As methamphetamine use appears to play a larger role in the addiction crisis, the medical community does not have the same tools to counter its misuse.
Naloxone and similar overdose reversal medications counteract opioid overdoses by blocking opioid receptors in the brain to quickly reverse the effects of an overdose. Narcan, a nasal spray version of naloxone, can be purchased and is kept in stock by public health departments, schools, police and fire departments and federal agencies nationwide. Chain retailers such as CVS, Walgreens, Rite Aid and Walmart began selling Narcan over the counter without a prescription.
But there is no medication approved by the Food and Drug Administration for overdoses involving stimulants such as methamphetamine.
Opioid substitute medications such as methadone and buprenorphine are used to reduce cravings and ease withdrawal symptoms from opioids. There are no equivalent medications, however, for people who are dependent on methamphetamine or other stimulants, Dawson said.
That deficit is glaring, Dawson said: “We need effective treatments for stimulant-use disorder.”
Meth samples more common in the West
The Millennium report also found that drug use differed by region, and methamphetamine samples were detected more frequently in the western U.S.
Methamphetamine was detected in more than 70% of fentanyl-positive urine samples in the Pacific and Mountain West states. Meth showed up least often in fentanyl-positive samples in the mid- and south-Atlantic states, the report said.
Cocaine appeared to be more prevalent in the eastern U.S. More than 54% of fentanyl-positive samples in New England also had cocaine. By comparison, fewer than 1 in 10 of the samples showed cocaine in the mountain region of the West, the report said.
Other findings from the report:
∎ The presence of cocaine samples in fentanyl-positive specimens surged 318% from 2013 to 2023.
∎ The presence of heroin in fentanyl-positive specimens dropped by 75% after a peak in 2016.
∎ The presence of prescription opioids in fentanyl-positive specimens dropped to an all-time low in 2023, which researchers cite as evidence that the U.S. addiction crisis has shifted from pain medications.
Nationwide, the addiction epidemic has evolved to a phase in which people are often using multiple substances, not just fentanyl, Volkow said. This polysubstance abuse complicates matters for public health authorities seeking to slow the nation’s overdose deaths.
Volkow said reports such as Millennium Health’s are important because they give researchers a snapshot of the nation’s evolving drug use and provide more timely data than death investigations from overdoses can offer.
Ken Alltucker is on X, formerly Twitter, at @kalltucker, or can be emailed at alltuck@usatoday.com.
