Earlier this week, I received a call from Stephen Murray. Never use alone The hotline keeps responders on the phone with drug users so they can call emergency services in case of drug overdose. Murray asked questions to gauge the callers’ reactions, but there was a pause in the conversation for about 15 minutes, and he could hear their breathing become shorter and less frequent during the call.
“It got to the point where I said, ‘Okay, I have to call you right now because I can’t confirm if this is life-sustaining,'” Murray told Salon in a phone interview.
Murray, a harm reduction program manager at Boston Medical Center, is an overdose survivor himself and an EMT. He founded the hotline, now known as the Massachusetts Overdose Prevention Helpline, in his 2019 year as a form of harm reduction. Since then, Murray and his team have responded to more than 500 consultations in the state and abroad, with a growing number of people who identify as primarily or exclusively stimulant users. He said that he witnessed this with his own eyes.
To explain this phenomenon, some drug policy experts have used a “wave” model.
is more than 1 million people died Since 1999, the number of deaths due to drug overdose has steadily increased each year. In his 12 months to April 2022,11,000 people experienced fatal overdose, according to the latest preliminary data from the Centers for Disease Control and Prevention. The crisis is so pervasive that nearly as many Americans died from drug overdoses last year as from drug overdoses. Diabetes.
To explain this phenomenon, some drug policy experts have used a “wave” model. In the first “wave” of the crisis, in the early 2000s, overdose deaths were primarily caused by prescription opioid use. Due to the supply of medicines, limited over time, People who were already using opioids turned to other drugs instead. A second wave in 2010 saw an increase in heroin users, followed quickly by a third wave in 2013 with synthetic opioids such as fentanyl, which were responsible for two-thirds of overdose deaths in 2022.
New research confirms that many people have i doubt it: We are currently in the midst of a fourth wave of overdose crisis caused by the use of multiple substances, including not only opioids but also meth.writing in diary Dependence, Researchers found that the rate of overdose deaths caused by the combination of fentanyl and methamphetamine increased from 0.6% in 2010 to 32% in 2021, with the rate of increase rising sharply in 2015.
Several the study have emphasized “Signs of death from multi-substance overdose can be traced back decades,” and the signs appear to be getting stronger. And while prescription opioid and heroin overdose deaths in waves one and two have declined over time, those first waves haven’t gone away, says study author and adjunct assistant professor Chelsea L. Dr. Schober emphasized. At the University of California, Los Angeles.
“All of that is still happening,” Shober told Salon in a phone interview. “It’s just making an already pretty dire situation even worse.”
“Ironically, the movement to take opioids off the shelves has made us less safe.”
The reasons behind the increase in overdose deaths from concurrent use of fentanyl and stimulants are complex and not fully understood.in washington post The number of prescriptions for hydrocodone and oxycodone fell 45% from 2011 to 2019, according to an analysis released this week, due in part to massive lawsuits against opioid manufacturers and changes in prescribing patterns in the medical community. It is a decrease. However, the number of deaths from prescription drug overdoses is remained almost the same.
“Ironically, the movement to remove opioids from shelves has made us less safe,” Murray said. “Overdose rates have risen from 20,000 to 100,000 per year, and opioid prescriptions are no longer the cause.”
Rather, the contributing factor may be an increase in counterfeit or contaminated pills circulating in the drug supply chain, said Dr. Daniel Ciccarone, a drug use researcher at the University of California, San Francisco. He is the person who coined the term “Fourth Wave” in relation to this issue. crisis. For example, a person attempting to take stimulants may unknowingly overdose on drugs containing fentanyl or other synthetic drugs.
Although people have historically combined drugs with opioids for similar purposes, fentanyl and other synthetic opioids are different.
Intentional use of multiple drugs is also possible. Murray said some people who use stimulants also take opioids or benzodiazepines to get over the high. Or vice versa, Schober added, people who use fentanyl or opioids may use stimulants to counteract some of the depressant effects.
Although people have historically combined drugs with opioids for similar purposes, fentanyl and other synthetic opioids are different. Because fentanyl is so powerful and unpredictable in its potency, overdoses occur primarily in people who identify as stimulant users, have relatively low opioid tolerance, and are unknowingly taking fentanyl. may be causing the deaths, Murray said. This also has implications for harm reduction, as those who primarily use stimulants may not have naloxone or other life-saving substances on hand at the time of drug use.
“If you’re intolerant to opiates and you’ve used meth for four or five days, and then you smell a little bit of fentanyl to calm yourself down, an autopsy will show both meth in your system and fentanyl in your system,” the system says. ” Murray said. “Maybe it was the fentanyl that killed you, but that person would not have been identified as at risk. [opioid] They weren’t regular opioid users, and they wouldn’t have said so in the interview, so it was an overdose. ”
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Shober’s study also showed that in the Northeast, cocaine is primarily used in combination with fentanyl, while methamphetamine is more commonly used in combination in other parts of the country.
That’s likely due to “a combination of very low-cost, high-purity methamphetamine surpassing cocaine and other stimulants at the national level, and a persistently well-entrenched illicit cocaine market in the Northeast and other parts of the country.” It seems to be. According to research.
Shober’s study analyzed data through 2021, but some addiction experts are already predicting a fifth wave of the overdose crisis based on what they’ve seen since then. . Murray, from Massachusetts, is particularly concerned about the simultaneous use of xylazine and opioids. Xylazine, a veterinary tranquilizer, is used to prolong the effects of the high caused by opioids, raising concerns that it could harm reduction groups across the country. Naloxone cannot reverse the effectsIt’s a preprint study An article released this week suggests that may be the case.
Ciccarone said concurrent use of xylazine could be classified as a fourth wave of polysubstance use, similar to stimulants. He also worries that counterfeit pills will contribute, or are already contributing, to the next big wave of overdose deaths.
“I think there will be a lot of talk about xylazine and counterfeit pills in the next few years,” Ciccarone said. “I’m not sure whether we should call this a fifth wave or abandon the concept of a wave.”
There are things you can do to reduce overdose deaths. emergency management Buprenorphine has been shown to be effective in treating stimulant use disorder. Successful treatment of opioid use disorder. Naloxone can reverse overdoses and allow you to take fewer doses. fatal overdose. Test strips can also alert people using drugs to the presence of potentially deadly contaminants.
But Murray said many of these solutions are just Band-Aids, and while critical to saving individual lives, they are ineffective at the scale needed to alleviate the crisis. However, large-scale policies designed to reduce overdose deaths have not been successful. Rather, with each new wave of overdose crisis, avoiding further deaths becomes increasingly complex.
“I’m really happy with the lives we saved,” Murray said. “But I’m also very frustrated on a larger scale by the lack of ability to find meaningful solutions.”
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