By Phil McCausland -
NBC News
The increase in drug overdose deaths experienced this year and in 2020 has caused concern among many researchers, physicians and health officials related to drug abuse and addiction, by a growing trend among victims that seems to indicate the emergence of a new and different wave of the opioid epidemic.
Although it appears that loneliness and the challenges of the coronavirus pandemic drove drug use, many experts say recent overdoses are partly due
to the use of fentanyl with other illicit substances.
Overdose deaths reached new records in the United States with more than 100,000 deaths this year, according to the Centers for Disease Control and Prevention, but experts say that is part of a fourth wave of the overdose epidemic, in the that an increasing number of drug users die with multiple substances in their bodies.
A Drug Enforcement Administration chemist inspects confiscated pills containing fentanyl at the DEA Northeast Regional Laboratory in New York in October 2019 Don Emmert / Getty Images
According to experts, behind that 100,000 death toll is a steady increase in the number of deaths from 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 Robert Anderson, chief of mortality statistics at the CDC's National Center for Health Statistics.
The joint use of fentanyl and other drugs marks this new trend in overdoses, which were previously characterized by the increasing use of prescription painkillers and the increase in the use of heroin and fentanyl individually.
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"I don't really refer to this as an opioid epidemic," said James Berry, director of addiction services and chair of the Department of Behavioral Medicine at West Virginia University.
"I refer to this as an addiction epidemic
, because the substance varies and usually more than one substance is used."
Although this trend has been identified, it is yet to be determined what is causing it: are users knowingly using fentanyl and other drugs, or is fentanyl entering the illicit drug market through dealers and distributors?
"It could be happening at any point or at multiple points along the drug supply chain," said Kelly Dougherty, Vermont's deputy health commissioner for alcohol and drug abuse programs.
“Some people want to use fentanyl, despite the dangers, and other people use it without knowing it, it's scary.
People are adulterating it and that makes it more deadly, ”says Dougherty.
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Although Vermont is working to make fentanyl test strips more accessible so that users can check whether drugs are contaminated, Dougherty said people should assume that, most of the time, any illicit drug they buy may contain fentanyl.
"Cocaine and fentanyl on purpose"
This year, the Biden Administration announced that state and local governments can use federal funds to purchase fentanyl test strips in hopes of curbing the rise in overdose deaths.
But many experts believe that fentanyl is entering the massive drug supply when it is distributed.
It appears that
dealers are adulterating other drugs with fentanyl, because it is cheap and provides a strong effect,
or they accidentally contaminate other substances by using dirty work surfaces, gloves, and tools.
"There are cases where patients will use cocaine and fentanyl on purpose," said Berry, citing some of his interactions with patients.
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"But much of this happens because today almost all the substances you can find on the streets are adulterated with fentanyl," Berry said.
However, aside from anecdotes and assumptions, there is little firm data on why a growing number of overdose victims have multiple substances in their bodies when they die.
Daniel Ciccarone, an addiction and drug researcher at the University of California, San Francisco, said it is unclear whether the majority of overdoses are caused by the intentional use of fentanyl with other drugs or whether the contamination or alteration occurs at the level of the drug. distributor.
And he stated that the real reason is a kind of "black box" that needs to be clarified with more research.
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"I think the contamination hypothesis is exaggerated and based on fear," said Ciccarone, who has published several articles on the fourth wave of overdoses and is working on a study on the causes behind this trend.
“There is evidence from across the country, a couple of articles that have already been published, but also data from my research in places like West Virginia shows that the combined use of methamphetamine or a strong stimulant with a powerful opioid is a popular combination.
This is a large and growing phenomenon, it is something that we cannot ignore ”, he added.
Unfortunately,
the problem is multi-factorial.
Brendan Saloner, a professor at the Johns Hopkins School of Public Health who studies drug addiction and its treatments, said fentanyl is moving across the country, affecting communities that have not had to deal with the opioid epidemic.
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"It seems like what's happening is that a lot of the overdose risk has shifted to parts of the country that weren't as susceptible before, so I think it's taking a lot of people by surprise," Saloner said.
"Certainly in some places, especially west of the Mississippi, things seem to be very bad," he warned.
Beyond that, Saloner said, state and local governments must work to rebuild addiction treatment and systems of care that were neglected during the pandemic.
Addiction services, he said, should be the main focus of efforts right now.
Saloner says the United States must expand the offering for users of these services and work in areas that do not have the resources to address the opioid epidemic.
“Environments like hospital emergency departments, where most people cannot receive treatment, or prisons, need more attention.
There are many critical systems that are not helping people in the right way right now, ”he said.