Move over, fentanyl? Stimulant overdose deaths are rising fast

Deadly, addictive fentanyl has certainly earned the spotlight when it comes to overdose deaths — but carnage from stimulants like methamphetamine and cocaine is rising at a much faster clip.

Over the span of a single year, heroin deaths dropped almost 34% nationwide, while deaths from natural and semi-synthetic drugs (morphine, codeine, oxycodone, hydrocodone) dropped nearly 13%. Methadone deaths dropped 1.1%, according to federal data presented at the recent American Society of Addiction Medicine conference in Dallas.

That’s the “good” news, if you will. The bad news includes the fact that deaths related to synthetic opioids — mainly fentanyl — jumped 5.7% between 2022 and 2023. But deaths related to methamphetamine jumped even faster — by 6.4% — while cocaine-related overdoses rose a striking 12.2%.

In California, this plays out on a backdrop of increasing homelessness. Many folks on the street use methamphetamine to stay awake at night to avoid becoming crime victims — especially women. It’s cheap, easy to get, highly addictive and creates its own special kind of hell.

Chronic meth users can exhibit violent behavior, anxiety, confusion, insomnia and psychotic features including paranoia, aggression, visual and auditory hallucinations, mood disturbances and delusions, such as the sensation of insects creeping on or under the skin, according to the Drug Enforcement Agency.

Deaths related to psychostimulant use have more than doubled in California over just three years, according to state data.

• In 2019, there were 2,875 deaths related to psychostimulant use in California. That includes 571 in Los Angeles County; 288 in San Diego County; 209 in Riverside County; 153 in Orange County; and 123 in San Bernardino County.

• In 2022, there were 5,833 deaths related to psychostimulant use in California. That includes 1,361 in Los Angeles County; 588 in San Diego County; 517 in Riverside County; 412 in Orange County; and 197 in San Bernardino County.

While there are good medications for managing opioid use, and OK medications for managing alcohol use, there are no FDA-approved medications for managing stimulant use disorders — yet.

Medicine?

Right now, treatment is confined mainly to behavioral therapies, said Dr. Madhukar Trivedi, professor of psychiatry at the University of Texas Medical Center.

But researchers are studying the use of many different medications as interventions for meth use disorder, including naltrexone plus bupropion, as well as the efficacy and safety of ketamine, which can be useful to treat depression. Buprenorphine, the gold standard for opioid treatment, may hold promise as well.

For cocaine, a recent study suggested genetic variation played a role in how well people responded to buprenorphine plus naltrexone during treatment. Trivedi said more work is needed to better understand mechanisms in the body that might improve substance abuse treatment.

Researchers are also excited about using artificial intelligence to zero in on drugs that might be repurposed for cocaine and methamphetamine treatment. Ketamine has shown promise here as well, said Rong Xu, a professor at Case Western Reserve University in Ohio.

Pharmaceuticals aren’t everything. A non-drug intervention that’s getting attention is using magnets to stimulate the brain, said Dr. Kathleen T. Brady, distinguished professor at the Medical University South Carolina.

Transcranial Magnetic Stimulation was approved to treat depression in 2008 by the FDA. While the mechanism is not well understood, studies suggest it has great potential for substance use treatment.

All good science leads to more questions, the researchers said. Relapse is common in substance use treatment — between 40% and 60% — but that’s in line with other chronic conditions and underscores the importance of medication as the first line of treatment, hand-in-hand with deep-rooted behavior changes. This isn’t “either-or.” It’s “and.”