Stimulants and Fentanyl are Becoming the Fourth Wave of the Opioid Crisis

A new study published this week in the scientific journal Addiction reports that overdoses involving both fentanyl and stimulants have increased 50-fold since 2010 and were responsible for 32% of all drug overdoses in 2021. This study highlights two major issues facing the American public – the continued, overwhelming presence of illicit fentanyl on the streets and the ever-growing rates of stimulant misuse and addiction across the country.

These startling findings are being referred to as the “fourth wave” of the overdose crisis in the United States, with the first wave being prescription opioids in the early 2000s, the second wave being the rise of heroin around the start of the 2010’s, and the third wave being the introduction of fentanyl around 2013. The combination of cocaine or methamphetamine in particular with fentanyl is quickly becoming the dominant force in the U.S. overdose crisis, with the Northeast seeing higher rates of cocaine/fentanyl overdoses while the rest of the country is witnessing a rise in methamphetamine/fentanyl overdoses.

What are Stimulants?

Stimulants, often referred to as “uppers” or “speed”, are substances that accelerate the body’s systems, such as the cardiovascular, respiratory, and nervous systems. Cocaine and methamphetamine (or “meth”) are two of the most popular illicit stimulants on the market, as are crack, synthetic cathinones (such as bath salts), khat, and kratom.

In low doses, illicit stimulants can produce effects ranging from euphoria and heighted feelings of wellbeing to increased blood pressure and talkativeness. When consumed in high doses, however, stimulants can lead to more severe effects, including anxiety, hyperthermia, seizures, and coma.

Unfortunately, regardless of how long someone has been using illicit stimulants, death can occur as a result of their chosen stimulant being laced with another substance, especially fentanyl. This means that a person can suffer a fatal overdose the very first time they experiment with illicit stimulants.

Stimulants and Fentanyl: A Deadly Combination

Stimulants and opioids like fentanyl inherently produce warring effects. In particular, cocaine, methamphetamine, and other stimulants increase the body’s need for oxygen while opioids like fentanyl produce slowed respiration rates, causing less oxygen to travel through the body. There are several reasons why misusing stimulants and fentanyl together can lead to an overdose, however it is often system overload produced by these physiological impacts that lead to fatalities.

Riding the Fourth Wave: What are the Options?

Substance misuse and addiction are not issues that are likely to vanish overnight, if ever. Remaining in a state of denial or feeling hopeless will do little to help us ride out this fourth wave, but perhaps only complicate it. The most effective approach that can be taken to address this issue is providing more access to resources and treatment, where individuals who are struggling to put an end to their active misuse of drugs can be connected to the people who can help guide them towards recovery.

Unfortunately, making accessible these resources and treatment options can be a multi-faceted operation, sometimes leaving individuals struggling against barriers that keep them from getting the help they need. Working directly with insurance providers and local treatment centers can give individuals additional options for obtaining life-saving care.

This past August, the manufacturers of Narcan, the opioid overdose reversal medication, announced that they will begin selling it over-the-counter, allowing for greater accessibility. Narcan can always be administered in the event of a suspected overdose, as it will not cause any harm if someone is not overdosing on opioids. Having Narcan on hand, whether you are someone who struggles with substance misuse or addiction or a loved one of someone who does, can equip you with a tool that might potentially provide a second chance at life.

At our inpatient rehab in Las Vegas, we can help you identify the levels of addiction treatment that meet your needs best, as well as inform you of the many ways that you can cover the cost of treatment. Do not let anything stand in your way – call us right now at to get the help you deserve.


Was this page helpful?
Thank you for your feedback.

American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information. We strive to create content that is clear, concise, and easy to understand.

Read our full editorial policy

While we are unable to respond to your feedback directly, we'll use this information to improve our online help.

You aren't alone. You deserve to get help.
Desert Hope is located in Las Vegas, Nevada, which is easily accessible from most locations in the Southwest. We offer a full continuum of care that spans from inpatient medical detox and rehab to outpatient services and sober living. Take the next step toward recovery: learn more about our addiction treatment programs near Vegas or learn about how rehab is affordable for everyone.