San Diego, California – 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 the laboratory Millennium Health, 60% of patients whose urine samples contained fentanyl last year also tested positive for methamphetamine, while 22% tested positive for cocaine.
This report represents the impact of the “fourth wave” of the nation’s overdose epidemic, which began with the misuse of prescription opioids, followed by a heroin crisis, and more recently, an increase in the use of illicit fentanyl. People battling addiction are increasingly using illicit fentanyl along with other substances, including stimulants such as methamphetamine and cocaine.
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. Overall, 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.
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.
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. 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, but there are no equivalent medications for people who are dependent on methamphetamine or other stimulants.
The Millennium report also found that drug use differed by region, with methamphetamine samples 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, while cocaine appeared to be more prevalent in the eastern U.S.
Researchers cite the presence of prescription opioids in fentanyl-positive specimens dropping to an all-time low in 2023 as evidence that the U.S. addiction crisis has shifted from pain medications. Volkow mentioned that the addiction epidemic has evolved to a phase in which people are often using multiple substances, not just fentanyl, which complicates matters for public health authorities seeking to slow the nation’s overdose deaths.
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.