Experts say it’s happened before.
In 2017, over 70,000 people died from drug overdoses - that’s 192 people a day. Opioid overdoses made up the majority of those deaths, but a rise in stimulant overdose deaths has experts warning of a growing stimulant epidemic.
On Thursday, the Centers for Disease Control and Prevention released a report outlining the sharp increases in overdose deaths involving cocaine and other stimulant drugs, and announced that they will expand overdose surveillance efforts to include stimulant-related overdoses.
What are stimulants?
Drugs such as cocaine, methamphetamine, and prescription drugs like Adderall, Ritalin, and Modafinil are all examples of stimulants. These drugs, sometimes called uppers, were first developed for medical use in the early 1900s to treat respiratory problems, obesity, and some neurological conditions. Today, prescription stimulants are primarily used to treat ADHD, narcolepsy, and depression that has been resistant to other treatments.
Stimulants increase a person’s alertness, attention, and energy, while also elevating heart rate, blood pressure, and respiration. “Stimulants, like other drugs of misuse, stimulate their own taking. Just taking them makes it more likely that you will take them again, and puts you in the risk group for compulsive and binge use despite consequences,” says Dr. Mark Gold, MD, a renowned addiction psychiatrist. Long-term, stimulants can have major health consequences, including cardiovascular damage, psychosis, memory loss, severe tooth decay and gum disease, and an increased likelihood of contracting infectious diseases.
Stimulant misuse is on the rise in the United States. Between 2005 and 2010, the number of emergency room admissions related to nonmedical use of prescription stimulants nearly tripled (SAMHSA DAWN Report). According to a survey by the Substance Abuse and Mental Health Services Administration, the number of people who met the criteria for stimulant use disorder rose by 32,000 from 2016 to 2017 (SAMHSA NSDUH).
Overdose deaths involving stimulants have also increased dramatically. In 2017, 13,942 people died from overdoses involving cocaine - up 34% from the previous year - while 10,333 people died from methamphetamine-related overdoses, a 32% increase from 2016, and nearly double the number of deaths in 2015 (CDC WONDER).
Historically, according to Yale drug expert and historian David Musto, stimulant crises have followed major opioid epidemics. The first cocaine epidemic of the late 1800s and early 1900s immediately followed an opioid epidemic, and the heroin epidemic of the 1970s was closely followed by a crack cocaine epidemic in the 1980s. Experts have several theories for why we may be approaching another stimulant epidemic.
Increased availability of stimulants
The United States is currently seeing an unprecedented supply of stimulants. Cocaine production in Colombia, one of the world’s largest producers, reached record levels in 2017 according to a United Nations report. According to the DEA, methamphetamine availability has also been on the rise, with prices on the decline.
Polysubstance use - that is, when a person uses more than one substance - is a growing factor in overdose fatalities. In 2017, nearly 75% of cocaine-related overdose deaths also involved opioids, as did half of psychostimulant-related deaths (CDC). Polysubstance use is common: 96% of people who use heroin - an opioid - report also using at least one other substance (CDC). According to Dr. Gold, “Recent reports from the street indicate that opioid users are ingesting stimulants to ameliorate opioid withdrawal.”
One driver of the increase in cocaine-related overdose deaths is adulteration, or the contamination of cocaine with fentanyl or other substances. Cocaine, in previous epidemics, killed by causing heart attacks, strokes, high temperatures and seizures. Now, many cocaine overdoses are caused by fentanyl, an incredibly potent synthetic opioid. Fentanyl and similar drugs were involved in more than half of cocaine-related overdose deaths in 2017 (CDC WONDER). In many cases, both street-level drug dealers and the people who use cocaine are unaware that the cocaine is laced with fentanyl.
Lack of medication-assisted treatment
While there are several safe and effective medications to treat opioid use disorders, there are currently no FDA-approved medications to treat stimulant use disorder. There are also no medications to reverse a stimulant overdose. Current treatments for stimulant use disorder include residential or inpatient rehabilitation, twelve-step programs, and evidence-based therapies such as cognitive behavioral therapy, and contingency-management interventions.
The signs are clear. To curb the current overdose crisis and prevent another epidemic in the near future, we must pay attention to the lessons of history—plain patterns that lay bare the limitations of substance-centric, short-sighted reform. “All drugs of misuse are dangerous by definition. Rather than focusing on this or that drug, we should look to prevent any drug misuse, and then we can prevent dependence,” says Dr. Gold. We must enact an urgent yet thoughtful response to the current crisis that reframes the necessary timespan and breadth of adequate addiction reform. This devastating moment contains an opportunity that this country cannot afford to squander.