New Study: Supply of Illicit Fentanyl — Not Illicit Stimulants — Associated with Increasing Overdose Deaths Involving Cocaine, Methamphetamine

RTI researchers analyzed law enforcement drug seizure data from Ohio spanning 2014 to 2019

RESEARCH TRIANGLE PARK, N.C. — A new study examining law enforcement drug seizure data in Ohio from 2014 to 2019 has found that fatal overdoses involving methamphetamine or cocaine, or both, were likely fatal because of the co-involvement of illicitly manufactured fentanyl rather than the involvement of illicit stimulants by themselves. 

“Our findings show that overdose deaths in Ohio involving illicit stimulants — cocaine and methamphetamine — were not in fact driven by increases in the market share of those stimulants,” said Jon E. Zibbell, Ph.D., a senior scientist at RTI International and lead author of the study. “This study demonstrates how pervasive fentanyl has become in the illicit drug supply and how supply-side data can help untangle what is actually driving stimulant-involved overdose deaths.”  

The research team used lab-tested drug seizure data as a proxy for the illicit drug supply and compared it to data on overdoses involving illicit stimulants to reach its conclusions.

According to the study, illicit stimulants were rarely seized in combination with fentanyl. Yet, increases in seizures containing both illicit stimulants and fentanyl were strongly associated with rates of stimulant-involved overdose mortality, suggesting that consumers of illicit stimulants may be increasingly exposed to fentanyl unknowingly.

“It’s hard to over-emphasize the growing risk of using illicit stimulants in the midst of a fentanyl epidemic,” added Zibbell. “People consuming cocaine and methamphetamine are doing so with the expectation that these stimulants do not contain illicit fentanyl, but unfortunately that is increasingly an unreasonable expectation. Even worse, stimulant consumers most often are people who don’t use opioids and have no tolerance, which means they are highly vulnerable to opioid overdose and likely unprepared to respond to an opioid overdose when it occurs.”

The study also supports previous findings that the illicit stimulant crisis is not a homogenous trend but encompasses two distinct and overlapping crises involving both cocaine and methamphetamine. Findings suggest that cocaine is disproportionately affecting Blacks or African Americans residing in large and medium metropolitan cities while methamphetamine is affecting Whites residing in small metros and rural jurisdictions.

Understanding how race, geographic location and illicit supply chains intersect can help public health agencies address both sides of the illicit stimulant crisis and respond more effectively to the health needs of urban and rural residents alike, the study authors note.

The authors conclude by recommending public health agencies elevate the overdose risk currently attributed to cocaine. They assert that cocaine’s risk profile should be placed on equal or greater footing compared with methamphetamine so prevention messaging more accurately aligns with drug overdose mortality data and highlights cocaine’s disproportionate impact on the health of urban communities of color.

The study was published today in Drug and Alcohol Dependence.

View the study