It Is No Longer Just an Opioid Problem: Polysubstance Misuse and the Fourth Wave of the Overdose Crisis

Course overview

The drug overdose crisis in the United States began in the 1990s. This crisis was fueled by a growth in opioid prescriptions by healthcare providers and is referred to as the "first wave." The first wave was followed by a second wave, driven by a rise in heroin use. A third wave followed, which was highlighted by the use of synthetic opioids. Now, a fourth wave has emerged in the opioid overdose crisis. This wave is marked by polysubstance misuse involving opioids (primarily fentanyl) combined with stimulants. These waves have caused a progressively higher number of drug overdose deaths in the United States. However, since late 2023, overdose deaths have steadily declined each month-a strong sign that public health interventions are making a difference and having a meaningful impact. This activity reviews the distinctive features of each wave of the drug overdose crisis, the increasing role of polysubstance misuse in the fourth wave, the emergence of novel substances, and the differences when assessing, diagnosing, and treating opioid and stimulant overdoses and use disorders.