The United States is sinking into the opioid crisis. With around 120,000 overdose deaths expected by 2023, the wave promises to reach an unprecedented level. TO “fourth wave”In fact, emphasizes epidemiologist Chelsea Shover, from the University of California, Los Angeles (UCLA). In an article published on Thursday, September 14, with his colleague Joseph Friedman in the magazine Addictionanalyzes its particularities.
How to characterize this fourth wave?
Sorry for this obvious, but it comes after three more waves. The first developed in the late 1990s, driven by the overprescription and misuse of legal opioids to treat pain. Beginning in 2010, we saw a significant increase in heroin overdose deaths among people previously addicted to opioid medications. A few years later, around 2013, fentanyl began to take control of the illicit drug supply, and deaths in much of the United States rose again.
Finally, in 2015 we began to observe that more and more deaths were occurring in the context of the association of this synthetic opioid and other substances, mainly the so-called stimulant drugs, cocaine, and methamphetamine. What we call the fourth wave is unprecedented: in 2015 there were around fifty thousand fatal overdoses. In 2022 the figures will exceed one hundred and ten thousand deaths, and without a doubt one hundred and twenty thousand in 2023.
Could you remind us how this crisis began?
For a massive increase in the prescription of opioids to relieve pain. This practice began to spread in the 1990s and early 2000s, reaching its peak in the 2010s. There was awareness and health authorities made sure to limit prescriptions. But it was too late. The dependent population was too large. Heroin market forces understood this and consumption changed.
Overuse of legal medications or heroin use are not the same. How did users go from one to the other?
For many users, excessive medication consumption was already based on illegal channels. They used painkillers that others bought: family members, friends, but also people who resold them on a parallel market. Heroin was cheaper and, in some cases, more available, as prescribing requirements had become stricter. The transition from one to the other, for people in a situation of dependence and often desperate to satisfy their need for drugs, was quite simple.