CDC data show most cocaine and psychostimulant overdose deaths also involve opioids

CNN
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Drug overdose deaths from psychostimulants such as cocaine and methamphetamine have risen sharply in the United States in recent years, and new report A U.S. Centers for Disease Control and Prevention study shows that opioids are also responsible for most of these deaths.

About 79% of cocaine overdose deaths and about 66% of psychostimulant deaths in 2021 had opioids, according to CDC data. And the combination of these drugs is becoming increasingly common.

Overdose deaths from both cocaine and opioids have increased more than seven-fold over the past decade, rising from less than one death per 100,000 in 2011 to almost six in 2021. Also, deaths from both psychostimulants and opioids increased 22-fold, jumping from 0.3 deaths per 100,000 in 2011 to nearly 7 in 2021.

Deaths from non-opioid cocaine and psychostimulants also increased, but at a much slower rate.

“This epidemic shows that it can be very dynamic and change very quickly,” said Katherine Keyes, an associate professor at Columbia University’s Mailman School of Public Health. Although he is not involved in the new report, his research focuses on psychiatry and the epidemiology of substance use. “This data is a stark reminder of how much more we need to do to combat these highly preventable deaths.”

The new CDC report doesn’t specify the types of opioids involved, but experts say the trends highlight the dangers of illicit fentanyl, a potent synthetic opioid.

“Combining cocaine and fentanyl is much more toxic and deadly. Methamphetamine alone can kill more people than cocaine, but that being said, when combined with fentanyl it is much more dangerous,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “This explains why we are seeing first-hand the high rise in mortality from these two drugs.”

But fentanyl isn’t the only factor, experts say, and it will take multiple strategic approaches to deal with a deadly overdose epidemic in the United States.

“The dramatic increase in cocaine and methamphetamine deaths over the past decade highlights that this is not an opioid crisis, but a polysubstance overdose crisis that requires a proven array of interventions to save lives,” said Sarah Wakeman, M.D., an addiction physician at Massachusetts General Brigham. He is not involved in this new report.

Both intentional and unintentional combinations of these drugs likely contribute to increased overdose mortality, she and others say.

Combinations of opioids and stimulants have been common among drug users for many years, with cocaine used for decades and, more recently, psychostimulants such as methamphetamine.

“Studies show that people who use both stimulants and opioids are at higher risk of health-related complications and that treatment models that address both are even more limited,” Wakeman said.

But fentanyl is also polluting the illicit drug market, increasing the risk of unintended exposure.

Dealers “are diluting or adding fentanyl to drugs that are expensive to produce,” Mr. Bolkow said. “They put in a small amount of fentanyl, which is cheap, but powerful enough to produce a powerful substance.”

This is especially true of cocaine, which is more expensive to manufacture and transport, and helps explain why the CDC’s new report has determined that cocaine and opioid combinations are so common, she said. And the amount of cocaine entering the United States increased significantly.

“The more drugs that enter the country, the more people will be exposed to mixing these drugs with fentanyl in the illicit market,” Bolkow said.

Another report said about 110,000 people in the United States died from drug overdoses in the past year. data set The CDC is tracking overdose deaths through February. About a quarter of those deaths were related to cocaine and a third to psychostimulants such as methamphetamine. More than two-thirds involved opioids.