The Evolving Nature of the U.S. Drug Epidemic

A NEW REPORT PROVIDES more evidence of the evolving nature of the U.S. drug crisis, showing increases in overdose deaths among people who used either cocaine or a psychostimulant like methamphetamine, whether alongside an opioid or not.

Researchers from the Centers for Disease Control and Prevention analyzed changes in drug overdose deaths related to cocaine and psychostimulants like meth, MDMA and others between 2016 and 2017. The data showed nearly a third – 23,139 – of the 70,237 drug overdose deaths in the U.S. in 2017 involved cocaine, psychostimulants or both.

"From 2016 to 2017, death rates involving cocaine and psychostimulants each increased by approximately one-third, and increases occurred across all demographic groups, Census regions and in several states," the study says.

Nearly 20% of drug overdose deaths overall involved cocaine, totaling 13,942 and marking a 34.4% increase from 2016, according to the report. Nearly three-fourths of those deaths also involved opioids, representing a nearly 40% increase from the total that did the year before.

The number of cocaine-involved deaths that did not involve an opioid also increased by more than 20%, from 3,112 to 3,811, the study's data shows.

The highest rate of deaths involving cocaine occurred among non-Hispanic blacks in 2017, at 8.3 per 100,000 population. The Northeast region of the U.S. had the country's highest death rate at 7 per 100,000, while Ohio (14 per 100,000) experienced the highest cocaine-involved death rate that year among 34 states with sufficient data for analysis.

The study also showed there were 10,333 deaths involving psychostimulants in 2017, representing 14.7% of total drug overdose deaths and a 37% increase from 2016.

About half of those deaths also involved an opioid in 2017, though the number that did not increased by about 24% – from 4,126 to 5,130 – from 2016. Meanwhile, law enforcement officials recently have pointed to a problem of cheap and potent forms of meth imported from Mexico into the U.S.

"Drug overdoses continue to evolve along with emerging threats, changes in the drug supply, mixing of substances with or without the user’s knowledge and polysubstance use," the CDC study says. "In addition, the availability of psychostimulants, particularly methamphetamine, appears to be increasing across most regions."

Non-Hispanic American Indians and Alaska Natives had the highest death rate among racial and ethnic groups in 2017, at 8.5 deaths per 100,000 population. The West had the highest psychostimulant-involved death rate in the nation, at 5.3 per 100,000.

Of the 34 states analyzed, West Virginia and Alaska had the highest psychostimulant-involved death rates at 13.6 deaths and 9.1 deaths per 100,000, respectively.

The researchers said that while cocaine-involved deaths from the longer period of 2010 to 2017 appear largely linked to the use of synthetic opioids like fentanyl, increases in psychostimulant-involved deaths in the same period "occurred largely independent of opioids, with increased co-involvement of synthetic opioids in recent years."

The authors noted that improvements in toxicology testing as well as variations among states in identifying specific drugs involved in a death may have impacted their findings.

Yet "increases in stimulant-involved deaths are part of a growing polysubstance landscape," the study says. And "because some stimulant deaths are also increasing without opioid co-involvement, prevention and response strategies need to evolve accordingly."

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