Expert warns of impending “fourth wave” of opioid epidemic

Expert warns of impending “fourth wave” of opioid epidemic

A fourth wave of the opioid epidemic is coming, a national expert on drug use and policy said during a virtual panel discussion this week hosted by the Berkshire County, Massachusetts, District Attorney’s Office and the Berkshire Opioid Addiction Prevention Collaborative.

Dr. Daniel Ciccarone, a professor of family and community medicine at the University of California, San Francisco (UCSF) School of Medicine, said the next wave in the country’s opioid health emergency will focus on stimulants like methamphetamine and cocaine, and drug combinations where stimulants are used in conjunction with opioids.

“The use of methamphetamines is back and it’s back big time,” said Ciccarone, whose most recent research has focused on heroin use.

Previously, officials had said there were three waves of the opioid epidemic – the first being prescription pills, the second being heroin, and the third being synthetic drugs, like fentanyl.

Now, Ciccarone said, what federal law enforcement and medical experts are seeing is an increase in the use of stimulants, especially methamphetamines.

The increase in deaths due to stimulants may be attributed to a number of causes: the increase in supply, both imported and domestically produced, as well as the increase of the drugs’ potency.

“Meth’s purity and potency has gone up to historical levels,” he said. “As of 2018, we’ve reached unseen heights of 97 percent potency and 97 percent purity. In a prohibitionist world, we should not be seeing such high quality; this is almost pharmaceutical quality.”

Additionally, law enforcement and public health experts like Ciccarone are seeing an increase in the co-use of stimulants with opioids, he said. Speedballs, cocaine mixed with heroin, and goofballs, methamphetamines used with heroin or fentanyl, are becoming more common from the Midwest into Appalachia and up through New England, he said.

Federal law enforcement officials are recommending local communities prepare for the oncoming rise in illegal drugs coming into their communities.

“Some people will use them both at the same time, but some may use them in some combination regularly,” he said. “They may use meth in the morning to go to work, and use heroin at night to come down.”

The co-use, he said, was an organic response to the fentanyl overdose epidemic.

“Some of the things that we heard … is that meth is popularly construed as helping to decrease heroin and fentanyl use; helping with heroin withdraw symptoms and helping with heroin overdoses,” he said. “We debated this for many years that people were using stimulants to reverse overdoses – we’re hearing it again.”

“Supply is up, purity is up, price is down,” he said. “We know from economics that when drug patterns go in that direction, use is going up.”

Ciccarone said that there should not be deaths because of stimulants, but that heroin/fentanyl is the deadly element in the equation.

His recommendations to communities were not to panic, but to lower the stigma surrounding drug use in order to affect change. Additionally, he said, policies should focus on reduction:  supply reduction, demand reduction and harm reduction; but not focus on only one single drug.

Additionally, he said that by addressing issues within communities and by healing communities socially, economically and spiritually, communities can begin to reduce demand.

“We’ve got to fix the cracks in our society, because drugs fall into the cracks,” he said.