Fentanyl and methamphetamine.
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Fentanyl and Methamphetamine: A Growing Polysubstance Use Crisis
Rising Trends in Fentanyl and Methamphetamine Co-Use
Increasing Positivity Rates in Urine Drug Tests
Recent studies have highlighted a significant rise in the co-use of fentanyl and methamphetamine. Analysis of urine drug test (UDT) results from 2013 to 2018 revealed a dramatic increase in the presence of nonprescribed fentanyl among methamphetamine-positive samples. Specifically, the positivity rate for fentanyl in methamphetamine-positive UDTs surged from 0.9% in 2013 to 7.9% in 2018, marking a 798% increase. This trend underscores the growing prevalence of polysubstance use involving these potent drugs.
Geographic and Temporal Trends in Drug Seizures
Data from the National Forensic Laboratory Information System (NFLIS) between 2011 and 2016 also indicate a significant rise in the presence of fentanyl in methamphetamine samples. The combined presence of these substances increased by 179% from 2015 to 2016, with notable geographic variations. States like New Hampshire and Massachusetts reported the highest incidences of fentanyl-methamphetamine combinations. This regional data highlights the need for targeted public health interventions.
Health Implications of Fentanyl and Methamphetamine Co-Use
Increased Overdose Risk
The co-use of fentanyl and methamphetamine significantly elevates the risk of overdose. Fentanyl, a potent synthetic opioid, is a leading cause of drug overdose deaths. When combined with stimulants like methamphetamine, the risk of fatal overdose increases, particularly among opioid-naive individuals . This combination poses a severe threat as users may unknowingly consume fentanyl-laced methamphetamine, leading to unintentional overdoses.
Ventilatory Effects and Naloxone Efficacy
Experimental studies on rats have shown that methamphetamine can attenuate the ventilatory depressant effects of fentanyl. While methamphetamine increases respiratory frequency, it decreases tidal volume, overall increasing minute ventilation. This interaction suggests that methamphetamine may partially counteract the respiratory depression caused by fentanyl, although it does not affect the efficacy of naloxone in reversing opioid-induced hypoventilation. These findings are crucial for understanding the physiological interactions between these drugs and for developing effective overdose reversal strategies.
Public Health and Policy Implications
Rising Mortality Rates
Methamphetamine-related mortality in the United States has seen a staggering increase, with a 50-fold rise from 1999 to 2021. A significant proportion of these deaths involved co-use with fentanyl, peaking at 61.2% in 2021. This alarming trend calls for robust harm reduction efforts and comprehensive surveillance to track and mitigate the impact of polysubstance use.
Need for Enhanced Surveillance and Prevention
The increasing prevalence of fentanyl in the stimulant supply necessitates strengthened community-based drug checking programs and enhanced public health surveillance. These measures can help detect and respond to rapid shifts in the drug supply, potentially reducing inadvertent exposures and overdose deaths. Additionally, continuous monitoring of local trends and rapid dissemination of information to active users are critical for mitigating the risks associated with fentanyl and methamphetamine co-use.
Conclusion
The co-use of fentanyl and methamphetamine represents a growing public health crisis, characterized by rising overdose rates and significant health risks. Enhanced surveillance, targeted harm reduction strategies, and comprehensive public health interventions are essential to address this complex issue. By understanding the trends and health implications of this polysubstance use, policymakers and healthcare providers can better protect and support affected individuals.
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