"The groundwork of all happiness is health." - Leigh Hunt

Increase in overdose deaths as a result of drug mixtures

January 4, 2024 – Experts are sounding the alarm that a mixture of pharmaceuticals and/or recreational drugs now accounts for nearly three-quarters Overdose deaths within the United States.

Reports on the usage of Fentanyl together with the animal tranquilizer Xylazine make stopping substance use disorders and related overdose deaths much more complicated, experts said during a webinar sponsored by the National Institute for Health Care Management.

“Nearly 74% of all cocaine-related overdose deaths are now attributed to synthetic opioids such as fentanyl,” said Dr. Cecelia Spitznas, senior scientific policy analyst within the White House Office of National Drug Control Policy. “This type of combined drug use is part of a new trend driving the overdose rate, along with increasing use of xylazine, or 'Tranq'.”

The White House approved the drug mixtures emerging threat against the United States in April.

As for overdose prevention, “If you use a substance yourself or know someone who uses substances, we're here to get people thinking,” Shawn Westfahl, overdose prevention and harm reduction coordinator at Prevention Point Philadelphia, said throughout the Webinar. Avoid consuming medications alone. “Most people who die from an opioid overdose die without anyone near them. We encourage people to use the buddy system and to stagger use.”

Westfahl also suggests that folks who use substances “go slowly and carefully, especially when injecting.” They can put more in; you may't take it out. And we encourage people to avoid mixing other drugs with opioids.”

Medically assisted treatment

Although equitable access is a challenge, “the most important thing we can do in the United States right now to combat the epidemic of substance use disorders is to increase access to evidence-based treatment, particularly medically assisted treatment,” Doug said Henry, PhD, vp of psychiatry and behavioral health at Allegheny Health Network in Pittsburgh.

For example, in 2020, Allegheny Health launched a program to extend access to medically assisted treatment in rural and underserved areas in West Virginia. Offering distant treatment “has really been a game-changer,” Henry said, particularly in regions with certain geographic and population density challenges.

Getting people into medically assisted treatment and keeping them in treatment is “tremendously, enormously important,” Henry said. “These efforts have resulted in a reduction in opioid-related overdoses.”

What worries the experts

Henry agreed that drug mixtures add to the challenge.

“The ongoing opioid epidemic and the emerging epidemic of combining molecules to produce deadly poisons are leading to increased rates of overdose,” he said. He has top marks in his two skilled positions – at Allegheny Health, a 14-hospital network in southwestern Pennsylvania and western New York, and at Highmark Health, the third-largest Blue Cross Blue Shield insurance company within the United States, which is primarily members serves West Virginia, Western New York, Delaware and Pennsylvania.

Westfahl reported that 1,413 people died of drug overdoses in Philadelphia in 2022, up from 1,276 overdose deaths in 2021, a ten% increase. Most deaths in 2022, 83%, involved opioids. Fentanyl and tranq remain a significant challenge for the population served by Prevention Point, he said.

“We are seeing a huge increase [in fentanyl use] “Over the years the number has steadily increased,” he said.

For example, in 2010, fentanyl was involved in fewer than 10% of drug overdoses. Last 12 months, fentanyl played a task in 96% of overdose deaths.

The national picture will not be rather more encouraging, said Spitznas. According to national survey data, about 25% or 70 million Americans used illegal drugs in 2022. More than 17%, or nearly 49 million Americans, reported a substance use disorder up to now 12 months.

Marijuana led to drug use amongst Americans ages 12 and older. In 2022, an estimated 62 million Americans used marijuana. Two of probably the most commonly used drugs fall into categories reminiscent of hallucinogens and painkiller abuse, each involving 8.5 million Americans. Additionally, nearly 5 million people have abused prescription tranquilizers and sedatives.

There has been a dramatic increase in deaths attributed to synthetic opioids and fentanyl, rising to almost 80,000 deaths in April 2023. Spitznas said the categories should not mutually exclusive because many drugs are used together. Additionally, “we believe that both heroin and fentanyl numbers are dramatically under-reported in national surveys.”

“Fentanyl is often used to contaminate certain substances, so it is unlikely that people truly know whether they are using heroin or fentanyl,” she said. If available, fentanyl and xylazine test strips might help determine what substances are present within the event of an overdose.

Good and bad news about treatment

National data also shows that only about 24% of Americans ages 12 and older who’re identified as needing treatment receive it. A silver lining might be seen in a breakdown by age group, Spitznas said. “We are doing a little better at getting 12 to 17-year-olds into treatment.”

Compared to the 25% of younger teens who receive treatment, “we're doing a really bad job of engaging 18- to 25-year-olds in treatment,” she said. The value is just over 16%. “And overall we need to get more people into treatment.”

Providing naloxone is a priority, Spitznas said. The FDA approved the primary over-the-counter nasal spray containing naloxone in March. The agency also approved a second drug to reverse opioid overdoses Nalmefene in May.

If an individual overdoses on each fentanyl and Tranq, the opioid reversal agents can treat the results of fentanyl. But xylazine or Tranq will not be an opioid. It is a veterinary drug that causes prolonged sedation and the FDA has not approved its use in humans.

“One way to think about it is that naloxone can restore breathing. If fentanyl and xylazine are used together, you may not regain consciousness quickly. But as long as breathing returns, that’s a good thing,” Spitznas said. “Therefore, we recommend continuing to take naloxone and calling 911 and seeking emergency services.”

Treatment for combination overdoses may not relieve withdrawal symptoms. “People addicted to xylazine can experience extreme withdrawal even when receiving medication for opioid use disorder,” Spitznas said. There aren’t any medications for xylazine withdrawal, she said.