The fourth wave: an opioid crisis

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simulation, healthcare, debrief, opioid
Tuesday, Oct 3, 2023

The opioid epidemic continues to grow and evolve. The number of people who died from a drug overdose in 2021 was over 6 times as many as died in 1999.  

And Montana is no exception.  Data presented from the Montana Office of Vital Records shows that drug poisonings are the 4th leading cause of death in the state. 

Ridin’ the waves

The opioid crisis has been categorized into waves. The first wave is thought to have begun in the late 1990s or early 2000s with a sudden rise of deaths due to prescription opioids. The late 90s saw a rise in pain clinics across the United States which contributed to a false sense of safety in use. Oxycodone and hydrocodone were believed to be non-habit forming and a great aid to helping chronic pain patients at the time.  

The second wave reared its insidious head around 2010 when the US saw a shift from opioids to illicit heroin. This could be attributed to a tightening down on accessibility to opioids with patients who were already hooked and needing a fix. 

Wave three started around 2013 with an increase in not only fentanyl use but its analogues as well. By changing the molecular compound of fentanyl by one molecule, it was legal for the sake of the definition. Evidence also shows that fentanyl and its derivatives was being sold as “heroin” (i.e. fentanyl adulterated or substituted heroin or FASH) during this wave.  

And now onto wave four…

Wave four started around 2015 where a rise of stimulant use with fentanyl and other opioid derivatives started to hit the streets. In conjunction, these drugs are known to result in unpredictable effects, drug toxicity, overdose, and death.  Overdoses are more difficult to detect, and victims are often found when it is far too late.  

Clandestine drugs can be extremely dangerous. Unlike those produced in a lab to be used pharmaceutically, those produced on the streets are unpredictable in the doses they contain.  

Analogy wise, it is like a game of Russian roulette. You could get the same drugs from the same dealers for years. And one time you get a batch that contains 1,000 times the potency of the batch you got before. There are no cures or reversal agents for drugs this potent. 

What's Next? 

As the opioid crisis continues to worsen and evolve, experts advocate for a comprehensive public health approach. 

This includes increased spending on treatment and harm reduction, stigma reduction campaigns, and criminal justice policy reform among other treatment, prevention, and policy ideas. 

Education not only for providers but for lay persons on how to recognize polysubstance use and overdose will only increase in need as the waves of the opioid crisis evolve.   


Effects of Mixing Stimulants and Opioids

Understanding the Opioid Overdose Epidemic

Drug Poisoning Deaths in Montana, 2009-2020

The Rise of Illicit Fentanyls, Stimulants, and the Fourth Wave of the Opioid Overdose Crisis,and%20policy%20ideas%20%5B86%5D.