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Cited by 987Opioid Use Disorder TreatmentForensic Toxicology and Drug AnalysisHIV, Drug Use, Sexual Risk

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The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis

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Ciccarone, Daniel·2021·Current Opinion in Psychiatry
DOI 10.1097/yco.0000000000000717PMC PMC8154745
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Abstract

PURPOSE OF REVIEW: This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment. RECENT FINDINGS: Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder. SUMMARY: A 'fourth wave' of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.

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  • Fentanyl and related synthetic drugs are being used together with stimulants more frequently.

    “These synthetic drugs, particularly fentanyl and its analogs, are increasingly used with stimulants.10”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [10]

  • Some people may be unaware that the stimulants they use are contaminated with fentanyl or other opioids.

    “Others may be unaware that the stimulants they use are contaminated with fentanyl or other opioids.10”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [10]

    The “fourth wave: Stimulants in combination” section reports co-use of stimulants and opioids and deaths involving both. It does not say that stimulants were contaminated with fentanyl or other opioids, or that people were unaware of such contamination (searched for unaware use and contaminated stimulants). (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Metadata

Authors
Ciccarone, D.
Affiliations
University of California, San Francisco (US)
Corresponding author
Ciccarone, Daniel
ORCID
Ciccarone, Daniel
Venue
Current Opinion in Psychiatry
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-05-14
Volume
34
Issue
4
Pages
344-350
ISSN
  • 0951-7367 (ISSN-L)
  • 1473-6578
DOI
10.1097/yco.0000000000000717
PMC
PMC8154745
OpenAlex
W3160915496
Cited by
987
References
6
Citations by year
2026: 199 · 2025: 220 · 2024: 245 · 2023: 194 · 2022: 113 · 2021: 16
FWCI
25.29
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Opinion in Psychiatry (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
Funders
National Institute on Drug Abuse (R01DA037820)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
illicit fentanyl, synthetic opioids, opioid overdose, stimulant overdose, polydrug use, methamphetamine, cocaine, intravenous drug use, HIV, hepatitis C, opioid use disorder treatment, COVID-19 pandemic, opioid epidemic
MeSH terms
Opioid Epidemic, Opiate Overdose, Central Nervous System Stimulants, Analgesics, Opioid, Cocaine, Fentanyl, Humans, Methamphetamine, Illicit Drugs, Comorbidity, Cocaine-Related Disorders, Drug Overdose

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