This article was produced by Drug Reporter, a project of the Independent Media Institute.
The powerful synthetic opioid fentanyl is, according to data from the Centers for Disease Control and Prevention (CDC), the leading contributor to the nation’s drug overdose crisis, involved in more than 40,000 of the 70,000 overdose deaths in 2017. But it’s not just killing heroin addicts and pain pill poppers. The deadly opioid is also implicated in a dramatic increase of fatal overdoses involving cocaine and methamphetamine.
The CDC numbers show that cocaine overdose deaths have doubled since their last peak in 2006 and that cocaine is now implicated in roughly the same number of fatal overdoses as heroin. With methamphetamine, the rise in overdose deaths is even more dramatic, with the number increasing five-fold since 2010.
Now, more evidence suggesting the degree to which fentanyl is implicated in rising stimulant drug overdose numbers has emerged in the form of a massive analysis of urine samples taken in the course of medical practice. In a study published in the JAMA Network Open, the medication monitoring and drug testing company Millennium Health examined one million samples gathered between January 2013 and September 2018, and the results were dramatic indeed.
The study found that during that period, the presence of nonprescribed fentanyl among urine samples that also tested positive for meth jumped by nearly 800 percent, while the increase for cocaine was a whopping 1,850 percent. In 2013, fewer than one out of a hundred (0.9 percent) samples came back positive for both fentanyl and either meth or coke; by 2018, it was closer to one out of 10 (7.9 percent) for meth and one out of five (17.6 percent) for coke.
It’s unclear how much of this combination use is the result of distributors somewhere down the line cutting the meth and cocaine without the knowledge of consumers and how much of it is consumers deliberately combining the drugs. Either way, the numbers suggest a whole lot of people are speedballing, as the practice is known, whether they mean to or not.
Speedballing poses particular dangers. As the authors note, “The combination increases the risk of overdose, particularly from respiratory depression once the stimulant effects decline. Overdose risk is also heightened in stimulant users who may be opioid naive prior to fentanyl exposure; they may be at increased risk of adverse effects because of an absence of opioid tolerance.”
“The increasingly common concurrent use of fentanyl with cocaine or methamphetamine may help explain the recent sharp increases in overdose deaths involving stimulants,” said co-author Bob Twillman, Ph.D., in a statement announcing the study. “It is still undetermined if these combinations are created by dealers or users, and if by users if this simply reflects a shift from heroin to fentanyl as the opioid being used. Clinicians and patients both should be aware of the potential consequences of fentanyl exposure, knowingly or unknowingly, and take the necessary steps to maximize patient safety.”
The one million drug test results covered a broad spectrum of medically necessary urine drug tests ordered as part of routine health care, including pain management, primary care, addiction treatment, behavioral health, obstetrics and gynecology, and multispecialty groups. The results revealed positive results for cocaine or methamphetamine with non-prescribed fentanyl across all treatment specialties, although with variations.
Not surprisingly, people being treated for substance abuse had the highest rates of concomitant fentanyl and cocaine use, with more than one out of four (28.8 percent) samples reporting both drugs. All the other medical specialties reported both drugs at a rate of 10 percent or less. With meth, concomitant fentanyl use by people treated for substance abuse also ranked high (10.2 percent), but was even higher (11 percent) for “multispecialty and other.” As with cocaine, all other specialties reported rates of less than 10 percent.
For the study authors, the results signal an ongoing public health threat and should be a clarion call to doctors and other health care professionals to be on the alert and ready to expand overdose prevention efforts.
“The lack of awareness regarding the potentially deadly combination of fentanyl with cocaine or methamphetamine poses a significant risk to public health because of the heightened risk of overdose,” they write. “Additionally, clinicians need to be aware that patients presenting for treatment for suspected drug overdose or substance use disorder may have been exposed, knowingly or unknowingly, to multiple substances, including the combination of stimulants and opioids. This population may also benefit from access to the opioid overdose antidote naloxone. Prevention efforts previously targeted toward opioid users may require expansion to also reach stimulant users who may be at risk for fentanyl exposure.”