The Fourth Wave of the Opioid Epidemic
In Pawtucket, Rhode Island, a man identified as J.R. had a ritual. Before taking drugs, he would smell his supply first, hoping to sense the sweet scent of fentanyl – an exceptionally potent opioid often mixed with substances like cocaine. But relying on smell as a safety measure is risky, because it’s scientifically impossible to detect fentanyl in this way. This isn’t stopping drug users like J.R. from believing in it, but experts caution that this unproven method could be deadly.
Fentanyl has become the catalyst for what health professionals refer to as the ‘fourth wave’ of the opioid crisis. Initially, the pandemic began in the early 2000s with misuse of prescription painkillers. Then, around 2010, authorities reported a surge in heroin use. By 2015, synthetic opioids like fentanyl had entered the scene. Now, experts are warning about a fourth stage in this deadly epidemic.
Stimulants and Fentanyl: A Deadly Mix
Combining stimulants such as cocaine and methamphetamines with fentanyl, an opioid 50 times more potent than heroin, has led to a spike in drug overdoses. The risk intensifies because several stimulants users aren’t aware that they could be ingesting opioids, hence they fail to take the necessary precautions to avoid overdoses.
To determine if stimulants have fentanyl, users would need to employ drug-checking tools, like fentanyl test strips. The strips are considered the ‘best practice’ for harm reduction, a strategy advocated by federal health authorities to combat drug-related deaths.
Illegal stimulants mixed with fentanyl have been linked to a majority of fentanyl-related overdoses across the US. The specific stimulant used varies geographically, typically cocaine in the Northeast, while methamphetamine is common in the West and parts of the Midwest and South.
Impact on Minority Groups
Research reveals that the combination of fentanyl and a stimulant is the leading cause of drug overdoses in the US and disproportionately affecting Black and African American communities. This crisis has also begun to impact older Black Americans aged 55-64 and the Hispanic community in recent times.
Street-made fentanyl is particularly lethal because its potency is unpredictable. While hospitals have used medical-grade fentanyl safely due to regulated potency, its strength in the illegal market can vary wildly, making it highly dangerous.
The Use and Misuse of Fentanyl
The use of mixed substances, such as cocaine and fentanyl, can be either intentional or accidental. A recent study indicated varying habits among drug users, some using fentanyl intentionally and others unintentionally. Some people use stimulants to ward off rapid withdrawal symptoms from fentanyl.
There’s also the high-risk practice of mix-use, known as ‘speedballing’, using cocaine or meth with heroin that has existed for decades. Drug-pushers, often to increase their yield, mix the inexpensive synthetic opioid to a stimulant, or accidentally mix up bags.
Despite measures taken to increase awareness, many users still mistakenly believe that they are using pure cocaine or other stimulants – a misunderstanding that can have fatal consequences. The only sure way to be certain and safe is to use drug-checking tests.
In 2022, Rhode Island had the fourth highest rate of overdoses linked to cocaine, trailing behind Washington, D.C., Delaware, and Vermont. Furthermore, even users who have switched to pills from perceived riskier drugs like cocaine, to avoid fentanyl, are being impacted.
Personal Stories of Tragedy
Jennifer Dubois’ older son, Cliffton, was a victim of this lethal mixture. He was struggling with addiction from a young age. In 2020, after checking out of rehab and a few months later overdosing, he decided to avoid hard drugs and take pills instead. After obtaining counterfeit Adderall laced with fentanyl, he was found unresponsive.
Sadly, the death of individuals like Cliffton might have been prevented if they had used simple fentanyl test strips, which could have revealed the dangerous ingredient in the pills. The emergence of the fourth wave of the opioid epidemic is a stark reminder of the hidden and fatal dangers of drug use – especially when powerful opioids like fentanyl are involved.