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Urine drug tests are revealing a disturbing trend in the United States. We are knee-deep in what some experts are calling the opioid epidemic’s “fourth wave”. This is not only placing victims at greater risk, but poses a new challenges in the war on drugs.

In the late nineties and early 2000’s, the opioid epidemic gripped the nation. This was followed by a spike in heroin usage (the second wave). In 2013, the well publicized Fentanyl surge left a wake of overdose deaths in its trail.

The latest or 4th wave involves a polysubstance picture including Fentanyl in combination with Methamphetamine per emerging reports. Millennium Health, a specialty laboratory that provides drug testing services to monitor trends of use of prescription medications and illicit drugs.

The report is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care. Its findings offer alarming statistics and insights. Polysubstance use has become a rising epidemic. An overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. The most concerning is the dramatic increase in the combination of methamphetamine and fentanyl use. Methamphetamine, a highly addictive drug often in powder form that poses serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. A staggering 875% increase since 2015.

This nationwide spike in methamphetamine use alongside fentanyl marks a change in drug use patterns.

Polydrug use trends complicate overdose treatments. Although naloxone, an opioid-overdose reversal medication is effective against fentanyl, there isn’t an FDA-approved medication for methamphetamine overdose.

Both heroin and prescribed opioid use alongside fentanyl have dipped. Both Heroin and prescription opioids detected in fentanyl-positive urine tests dropped dramatically in 2023, down 89% since 2013.

Lower heroin use is not a silver lining. It is merely a reflection of the widespread hold and availability of Fentanyl in today’s illicit drug market. This changing dynamic in the drug market poses inherent dangers to users. The same bag or pill that users have been buying is now coming from a different place, a different supplier, and is possibly a different potency.

Drug suppliers dictate supply and availability of illicit drugs. Lab produced drugs like Fentanyl and Meth are far easier to produce in smaller, less detectable settings than the large acreage needed to produce cocaine.

Gauging patterns of use can be misleading. The potential of lacing of one drug with another poses the risk of unintentional use. Thousands of overdoses have been attributed to Fentanyl being laced along with cocaine, meth, or even marijuana. Discerning intentional polysubstance use versus unintentional lacing is a near impossible task. Gauging users intent in post treatment interviews or specimen analysis are potential methods to measure trends.

The nation’s drug crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, mostly because of fentanyl. This 4th wave of polysubstance abuse poses the most deadly of threats. With only Narcan to combat Fentanyl overdose, healthcare workers are unarmed to treat Meth, Xylazine, and other drugs of abuse now being laced and/or combined therein.

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