Scientists warn in research published Thursday that the United States is facing imminent "mass death" in the opioid crisis, expecting its most significant spike yet.
In a peer-reviewed study in JAMA Network Open, researchers at Northwestern University say deaths are rising from polydrug abuse, which commonly involves mixing synthetic opioids with stimulants such as cocaine and methamphetamines.
"I'm sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county," study author Lori Post, director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine, said in a press release. "Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high."
The researchers said the United States has seen as many as three overlapping major waves of opioid overdose deaths in the past two decades.
The first wave began around 2000, "prompted by doctors overprescribing opioid painkillers, which was associated with mass addiction," the researchers said.
The second wave arose around 2007, as heroin overdoses began to escalate and eventually surpassed those from prescription opioids by 2015.
The third wave was identified around 2013 due to the rise of synthetic opioids such as fentanyl.
The fourth and current wave, which is expected to be the deadliest one yet, was accelerated by the COVID-19 pandemic, researchers say.
"The opioid overdose crisis continues to worsen and evolve: Fentanyls are spreading westward in the USA and a new wave of stimulant and polydrug use is upon us," Daniel Ciccarone, an addiction medicine professor at the University of California San Francisco, wrote in a 2021 study about the upcoming fourth wave.
"The COVID-19 pandemic is accelerating the overdose crisis, as well as its racial and economic inequities," Ciccarone wrote. "Addressing disparities in access to treatment and prevention services, as well as criminal justice reforms are necessary to address this persistent syndemic."
While the opioid crisis has affected urban and rural areas differently in the past 20 years, this time researchers are saying numbers are spiking in both.
"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 said. "It's going to mean mass death."
Toxicology reports examined by Post and her team show that the overdoses usually involve the use of fentanyl, a synthetic opioid that can be 100 times more potent than morphine -- and carfentanil, which can be 100 times more potent than fentanyl.
"The stronger the drugs, the harder it is to revive a person," said Alexander Lundberg, assistant professor of emergency medicine at Northwestern, who co-authored the study with Post. "The polysubstance use complicates an already dire situation."
The researchers say the United States needs to invest in medication-assisted, anti-addiction treatments in order to put a dent in the crisis.
"The only path forward is to increase awareness to prevent opioid use disorders and to provide medication-assisted treatment that is culturally appropriate and non-stigmatizing in rural communities," Post said.
In February, another study said as many as 1.2 million people could die from drug overdoses across North America by the end of the decade.
The study, which also highlighted the role of the COVID-19 pandemic in worsening the opioid crisis, said deaths are also expected to increase worldwide.
