Between April 2020 and April 2021, 100,000 Americans lost their lives to drug overdoses. This is the highest number of overdoses ever recorded in a year, and an increase of 29% over the previous 12 months.
Opioids, and particularly synthetic ones such as fentanyl, are responsible for a majority of the deaths, killing 74,000. But overdoses from drugs such as cocaine or psychostimulants—including methamphetamines used to treat attention deficit disorder—that are less often associated with overdoses are increasing too.
In the past year, nearly 28,000 overdose victims had taken psychostimulants, and nearly 21,000 had taken cocaine. (The sum of all drugs linked to overdoses is larger than the actual cases because at times more than one drug is present).
While the overdoses from cocaine and stimulants aren’t as high as from opioids, the trend is concerning, particularly when it comes to stimulants. Cocaine overdoses increased 36% since prior to the pandemic, and those from stimulants went up 105%. By comparison, opioid overdoses rose 60% in the same period.
These increases in overdoses aren’t always linked to increasing consumption. Although there has been an increase in the supply of cocaine and methamphetamine, as well as fentanyl, since 2020, in many cases the increase in stimulants overdoses is linked with opioid use, says Kenneth Morford, an assistant professor of medicine at Yale who specializes in opioid addiction treatment in his clinical practice. “About 50% of stimulant overdoses, including both cocaine and methamphetamine, involve contamination with fentanyl,” he says.
While there have been reports of increases of non-opioid drugs—particularly cocaine—being laced with fentanyl and other opioids, researchers can’t yet tell whether drug users are intentionally combining the drugs, too.
Another issue with stimulants is that there aren’t as many resources to treat addiction as there are for opioids. With the focus on the opioid epidemics, not enough attention has been directed at preventing abuse of other drugs.
“Most harm reduction and treatment efforts have focused primarily on opioids. We don’t have overdose reversal medications for stimulants as we do for opioids. We also don’t have any FDA (Food and Drug Administration)-approved medications to treat stimulant-use disorder,” says Morford.
He adds that overdoses from cocaine and stimulants are disproportionately frequent among ethnic and racial minorities, suggesting a need for community-specific outreach and support. Cocaine overdoses have gravely impacted Black communities, while methamphetamine overdoses have had the biggest impact on Native American populations.
The Drug Policy Alliance, an organization focused on reducing the harm from drugs, has developed some policy suggestions (pdf) to reduce the risk of stimulants, including through initiatives in the worst-hit communities, decriminalization of drug use, and funding for treatment research, both pharmacological and behavioral.