The Evolving Overdose Epidemic: Synthetic Opioids and Rising Stimulant-Related Harms

Abstract The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999–2010), heroin (2011–2013), and illicit fentanyl and other synthetic opioids (2014–present). However, the increasing...

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Published inEpidemiologic reviews Vol. 42; no. 1; pp. 154 - 166
Main Authors Jones, Christopher M, Bekheet, Faraah, Park, Ju Nyeong, Alexander, G Caleb
Format Journal Article
LanguageEnglish
Published United States Oxford University Press 31.01.2020
Subjects
overdose
stimulants
heroin
psychostimulants
cocaine
methamphetamine
fentanyl
opioids
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Summary:Abstract The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999–2010), heroin (2011–2013), and illicit fentanyl and other synthetic opioids (2014–present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.
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G.C.A. is past chair of the Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee; has served as a paid advisor to IQVIA; is a cofounding principal and equity holder in Monument Analytics, a health-care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a member of OptumRx’s National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.
ISSN:1478-6729
0193-936X
1478-6729
DOI:10.1093/epirev/mxaa011