The Evolution of America’s “Fourth Wave” Overdose Crisis
Understanding the Four Waves of the Opioid Crisis: We often hear about the opioid epidemic, but it’s not a single monolithic event – it’s evolved in waves. To set the stage, Wave 1 started in the late 1990s with a surge in prescription opioid use (think OxyContin and Vicodin overprescribing). Wave 2 saw many people transition to heroin around the 2010s as prescriptions became harder to get. Wave 3 hit in the mid-2010s with the emergence of illicit fentanyl , a synthetic opioid vastly more potent than heroin, driving overdose deaths to new peaks. Now, we’re in what experts call the “Fourth Wave” – characterized by polysubstance overdoses, especially fentanyl mixed with other drugs like stimulants (cocaine, methamphetamine) uclahealth.org . This means people aren’t just overdosing on opioids alone; often it’s fentanyl combined with meth or cocaine (sometimes intentionally, sometimes unbeknownst to the user). From 2010 to 2021, the proportion of U.S. overdose deaths involving both f...
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