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Fourth “Wave” of Drug Overdose Death in US Will Be More Serious Than The Last One, CDC Data Shows

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“We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before. It’s going to mean mass death.”

A new study from Northwestern Medicine shows that where opioid overdose deaths have happened in the last 21 years—from prescription drugs to heroin to synthetic and semisynthetic opioids like fentanyl—geography has had an influence.

However, the results of the study imply that the upcoming wave will not make a distinction between rural and urban locations. The number of deaths from opioid-related overdoses is expected to rise dramatically in every type of county, from the most rural to the most metropolitan.

The study authors said that synthetic opioids mixed with stimulants like cocaine and methamphetamines make a deadly mix that is hard to reverse during an overdose. This is why the number of opioid overdoses has reached a record high.

“I’m sounding the alarm,” says corresponding author Lori Post, “because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county.” 

In addition to being at an all-time high, the fatality rate from opioids is also increasing, which indicates explosive exponential growth that will surpass the previous record high.

The findings were published in JAMA Network Open today.

The study looked at geographic trends in opioid-related overdose deaths between 1999 and 2020 to see if location played a factor in America’s opioid crisis’s three waves and anticipated fourth wave.

The authors used information from the WONDER database maintained by the Centers for Disease Control and Prevention for 3,147 counties and county equivalents that were rated on a six-point scale for urbanicity (most urban to most rural).

First geography-based analysis of acceleration rates

The authors of the paper said that, to their knowledge, no one has systematically analyzed acceleration rates of opioid-involved overdose death rates by location for each year, despite some academics having looked at an acceleration rate from one year to the next.

Post adapted the methodologies that she created in order to determine the potential hotspots of COVID-19 outbreaks to the issue of opioid abuse.

The study found that near the end of the available data from 2020, the number of overdose deaths in rural areas was rising faster than in cities.

According to Post’s analysis, rates of opioid-related overdose deaths increased in six different categories of rural and urban counties between 2019 and 2020.

Overdoses in rural and urban areas will spike, finds new study that gives geographic breakdown

“We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before,” Post adds. “It’s going to mean mass death.”

A very dangerous mix

The authors of the study looked at toxicology reports and found that people are using fentanyl, which is 50 to 100 times stronger than morphine, and carfentanil, which is about 100 times stronger than fentanyl, along with methamphetamines and cocaine.

The outcome is a potent and fatal mixture that is resistant to overdose-reversing medications such as naloxone.

According to research co-author and assistant professor of emergency medicine at Feinberg, Alexander Lundberg, “the stronger the drugs, the harder it is to revive a person.” 

According to research co-author and assistant professor of emergency medicine at Feinberg, Alexander Lundberg, “the stronger the drugs, the harder it is to revive a person.” 

According to Post, it appears that those who died from opioid overdoses tried to control their own dosing and played the role of the pharmacist. “This is a bigger problem because you have people misusing cocaine and methamphetamines along with an opioid, so you have to treat two things at once, and the fentanyl is horribly volatile.” 

What should we do?

Post says, “Nobody wants to be a drug addict.”  

It makes no difference whether you’re using Percocet because you injured your back working in mine or whether you were a high school student who died after breaking into your grandmother’s medication cabinet. Opioid addiction and overdose prevention require rapid attention.

Post noted that although they are normally only opened in metropolitan areas, that could take the shape of methadone or buprenorphine facilities, which provide medication-assisted anti-addiction therapies for heroin or synthetic and semi-synthetic opioid overdoses.

She added that there are no medication-assisted treatment alternatives available in rural places and that what is effective in big cities probably isn’t as helpful there.

The only way forward, according to Post, is to raise knowledge about how to prevent opioid use disorders and to offer culturally appropriate, non-stigmatizing medication-assisted treatment in rural communities.

Image Credit: Getty

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