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Proportion of stimulant involvement in fentanyl-involved overdose deaths increased in almost every state from 2015 to 2021

By 2021, stimulants were the most common drug class found in fentanyl-involved overdoses, according to a study published online Sept. 13 in Addiction.

Joseph Friedman, Ph.D., and Chelsea L. Shover, Ph.D., from the University of California in Los Angeles, and colleagues characterized co-involved substances in fatal overdoses involving synthetic opioids in a population-based study of national death records in the United States.

The researchers found that from 2010 to 2021, there was an increase in the percent of U.S. overdose deaths involving both fentanyl and stimulants, from 0.6 to 32.3 percent, with the sharpest increase starting in 2015. Fentanyl was most commonly found alongside prescription opioids, benzodiazepines, and alcohol in 2010. In the Northeast, this shifted to heroin-fentanyl co-involvement in the mid 2010s, while by 2021, it had nearly universally shifted to cocaine-fentanyl co-involvement. In the West and in the majority of states in the South and Midwest, by 2021, methamphetamine-fentanyl co-involvement predominated universally. From 2015 to 2021, in virtually every state, the proportion of stimulant involvement in fentanyl-involved overdose deaths increased. Particularly high rates were seen for older Black and African American individuals living in the West in an intersectional group analysis.

“We’re now seeing that the use of fentanyl together with stimulants is rapidly becoming the dominant force in the U.S. overdose crisis,” Friedman said in a statement. “This poses many health risks and new challenges for health care providers.”

One author disclosed ties to the pharmaceutical industry.

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