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There has been a record number of fatal overdoses in the U.S. in recent years. Matt Gush/Getty Images
  • A new CDC report finds that stimulants like cocaine and methamphetamines are being laced with opioids driving an increase in fatal overdoses.
  • Fatal overdoses have reached new heights in recent years thanks to deadly opioids like fentanyl.
  • In 2021, nearly 80% of all overdose deaths involving cocaine also involved an opioid.

Drug overdose deaths involving cocaine and methamphetamine in the United States have continued to rise over the past decade, but it is the presence of opioids that are driving these deaths, according to a new CDC report.

In a report published this week by the CDC, researchers looked at drug overdose deaths in the United States between 2011-2021.

During the 10-year study period, overdose deaths involving more than one substance or poly-substance overdoses involving cocaine and opioids increased from 0.8 deaths per 100,000 in 2011 to 5.9 per 100,000 deaths in 2021 — a seven-fold increase.

The rate of overdose deaths involving psychostimulants (drugs like methamphetamines and amphetamines) and opioids also increased dramatically from 0.3 in 2011 to 6.7 in 2021 — a 22-fold increase.

In 2021, nearly 80% of all overdose deaths involving cocaine also involved an opioid. Similarly, overdose deaths involving psychostimulants involved opioids in 65.7% of cases.

“This report highlights that rates continue to rise for drug overdose deaths involving cocaine as well as for drug overdose deaths involving psychostimulants…Notably, the majority of drug overdose deaths involving these drugs involved an opioid” Merianne Rose Spencer, a researcher at the National Center for Health Statistics, Centers for Disease Control and Prevention, and lead author of the report told Healthline.

Drug overdose deaths did increase for cocaine and psychostimulants without opioid involvement over that same period.

However, the increases for the drugs individually (without opioid involvement) were relatively modest compared with the explosion of deaths driven by those with opioid involvement. Overdose deaths from cocaine alone doubled in the past decade, from 0.7 per 100,000 in 2011 to 1.5 per 100,000 in 2021. Meanwhile, deaths from psychostimulants without opioid co-involvement increased six-fold from 0.5 per 100,000 in 2011 to 3.3 per 100,000 in 2021.

Interestingly, in the first five years of the study period, psychostimulants alone initially accounted for more overdose deaths than when involved with opioids. However, by 2017 psychostimulant deaths involving opioids surpassed psychostimulants alone and has climbed rapidly ever since.

The CDC report also found regional differences in overdose deaths. The majority of drug overdose deaths involving both cocaine and opioids was in the northeast region of the United States; 84.5% of all cocaine deaths in this region involved opioids.

The western region had the lowest rate of opioid involvement at 73.4%.

Psychostimulant overdose deaths followed a nearly identical trend: the highest level of opioid co-involvement was in the Northeast, found in 80.6% of overdose deaths. The West again had the lowest percentage of opioid co-involvement at 57.5%.

Deaths from drug overdose have exploded in the United States in recent years. Opioids, specifically high-potency synthetic opioids like fentanyl, have been identified by both healthcare professionals and law enforcement agencies as the culprit. Of the approximately 107,000 overdose deaths in the United States in 2021, 80,411 of them were found to involve some kind of opioid.

The CDC’s new findings are clearly in line with this trend.

“This report emphasizes that opioid-involvement continues to drive overall increases in drug overdose deaths in the United States, where overdoses from cocaine and overdoses from drugs like methamphetamine, are often not acting alone in causing overdose deaths,” said Spencer.

Dr. Rais Vohra, medical director at California Poison Control and a professor of emergency medicine and clinical pharmacy at the University of California, San Francisco, told Healthline that this study shows just how pervasive opioids have become in the illicit drug supply in the United States.

“This [study] adds a new dimension to just how much of a crossover there has been…There may be this impression in the lay population and even in the general medical community that all of these drugs are being used in silos, when in fact the reality of street drug use is that no one really knows what’s in their supply,” he said.

The CDC report does not specifically note whether or not the poly-substance usage involved in overdose deaths was intentional or accidental. That is, it is not clear whether users intentionally sought out different drugs to use in combination, or if the drugs they were using had been adulterated with other substances.

For healthcare workers like Vohra and law enforcement officials, the reason behind opioids showing up in other drug supplies is obvious: fentanyl and other synthetic opioids are cut into other drugs to boost potency and profit.

“Fentanyl has certainly infiltrated the drug supply,” Vohra said, “and this study really points to the fact that it’s not just people who think they are doing opioids. It’s really everyone.”

Due to the proliferation of fentanyl and other high-potency opioids, Vohra strongly encourages everyone to become familiar with the lifesaving overdose-reversing drug naloxone, also known by its trade name, Narcan.

“Hopefully naloxone is a household word,” said Vohra, “At this point, we’re certainly trying to get it distributed as broadly as possible. Learn about naloxone and try to undergo a brief training on it, because that will actually arm you with the knowledge and the medication to save lives.”

Learn to recognize the signs of an opioid overdose here.

A new CDC report finds that many stimulant drugs now also contain fentanyl. This mix of fentanyl and stimulants is linked to a significant rise in overdose deaths.