More Americans than ever are dying from fentanyl overdoses as the fourth wave of the opioid epidemic sweeps through every community, in every corner of the country.
Six years ago, Kim Blake’s son Sean died of an accidental fentanyl overdose in Burlington, Vermont. He was 27 years old.
“Every time I hear about a substance abuse loss, my heart breaks a little more,” Blake wrote in a blog dedicated to her son in 2021.
“Another family devastated. Always grieving the loss of dreams and celebrations.”
That year, the United States witnessed a grim milestone: for the first time in history, drug overdoses killed more than 100,000 people nationwide in a single year.
Of those deaths, more than 66% were related to fentanyl, a synthetic opioid 50 times more powerful than heroin.
It’s a marked difference from a decade ago. In 2010, fewer than 40,000 people died from drug overdoses nationwide, and fewer than 10% of those deaths were related to fentanyl.
Back then, deaths were primarily due to heroin or prescription opioid use.
The contrast is described in a study published this week conducted by researchers at the University of California, Los Angeles (UCLA), examining trends in overdose deaths in the US between 2010 and 2021 using data compiled by the US Centers for Disease Control and Prevention. USA
The data paints a clear picture of how fentanyl has redefined drug overdoses in the United States over the past decade.
“The rise of illicitly manufactured fentanyl has led to an overdose crisis in the United States of unprecedented magnitude,” the study authors wrote.
Virtually every corner of the United States, from Hawaii to Alaska to Rhode Island, has been touched by fentanyl.
Data shows that the increase in fentanyl-related deaths was first observed in 2015.
Since then, the drug has spread throughout the United States and death rates have increased sharply.
“In 2018, about 80% of fentanyl overdoses occurred east of the Mississippi River,” Chelsea Shover, assistant professor at the UCLA School of Medicine and co-author of the study, told the BBC.
But in 2019, “fentanyl becomes part of the drug supply in the Western U.S. and suddenly this population that had been isolated from it is exposed and death rates start to rise,” the Professor Shover.
In their study, researchers warn of another growing trend: deaths related to the use of fentanyl and other stimulant drugs, such as cocaine or methamphetamine.
This trend is seen throughout the United States, although in different ways due to drug use patterns that differ from region to region.
For example, researchers found higher mortality rates related to fentanyl and cocaine use in northeastern U.S. states, such as Vermont and Connecticut, where cocaine has traditionally been more available.
But in virtually the rest of the country, from West Virginia to California, deaths were primarily due to the use of both methamphetamines and fentanyl.
Ms. Blake, who is also a doctor, said her son used cocaine sporadically, although his toxicology report revealed only fentanyl in his system.
He learned that many use fentanyl along with another stimulant to achieve a long-lasting effect.
“I’m not surprised that we are seeing such an increase in combinations of stimulants and opioids,” Blake told the BBC.
When fentanyl first arrived in the United States as part of the illegal drug supply, “a lot of people didn’t want it,” Professor Shover said. But the synthetic opioid became widely available because it is cheaper to produce compared to other drugs.
It is also highly addictive, meaning that people who struggle with substance use and are exposed to it often seek it out to avoid painful withdrawals.
Across the United States, the study identified states such as Alaska, West Virginia, Rhode Island, Hawaii and California as having the highest rates of fentanyl and other drug overdose deaths.
These states have historically high rates of drug use, Professor Shover said. With the arrival of fentanyl, drug use in these areas has become more lethal.
It’s no longer just a “white problem”
The opioid crisis has traditionally been portrayed as a “white problem,” Professor Shover said.
Their study, however, revealed that African Americans are dying from a combination of fentanyl and other drugs at higher rates, across all age groups and geographic lines.
For Rasheeda Watts-Pearson, a harm reduction specialist based in Ohio, the data reflects what she has seen in her region.
He has been doing outreach work with A1 Stigma Free, a grassroots organization founded just eight months ago to address a notable increase in overdose deaths within the African American community in Cincinnati.
As part of her job, Watts-Pearson frequently visits barbershops, bars and grocery stores to talk to people about the deadly effects of fentanyl.
He said he does this because of a lack of awareness, driven in part by historical disparities in health care experienced by racial and ethnic minority groups.
Even marketing campaigns conducted to raise awareness about the opioid crisis have not included the experience of black Americans, he said.
“I can drive down Avondale right now, there’s a sign that says ‘Opioid Crisis,’ but there are two white people on that sign,” Ms. Watts-Pearson said.
A big blind spot for his community has been street drugs laced with fentanyl, he said, which has led to people unknowingly using the deadly synthetic opioid and developing a dependence on it.
“The coroner’s office is seeing people overdose and die from cocaine, crack, pills and traces of fentanyl,” he said.
“Now it’s infiltrated the black community and there aren’t enough people talking about it.”
A fourth wave
The lethal use of fentanyl in combination with other drugs has marked the “fourth wave” of the overdose crisis in the United States, researchers have said.
And experts like Professor Shover have warned that treatment options in the United States for substance abuse have not kept up.
“Our treatment system for substance use disorder often focuses on one drug at a time,” Professor Shover said. “But the reality is that many people who use drugs use more than one type of drug.”
To keep her son’s memory alive, Ms. Blake has spoken openly about her loss and has helped other families overcome the pain of losing a loved one to an overdose.
“Everyone has a story, and for a parent who has lost a child, that is forever,” he said.
Her son had been enrolled in treatment several times during his battle with substance use disorder.
The experience taught Ms. Blake that care options vary from state to state, and in many cases, what is available is not enough.
“Ideally, we would like to see something where people get treatment quickly, when they want it, and for the long term,” he said.
Ms. Blake also raised the idea of creating overdose prevention sites, where people can use drugs safely and under supervision.
Those sites are widely available in Canada, which has its own fentanyl crisis, but there are only two authorized sites in the United States.
Above all, Ms. Blake has called for compassion and understanding for those struggling with substance use.
“Most people I talk to, their children didn’t want to die,” he said.