A 2023 study found illicit stimulants mixed with fentanyl were the most common drugs found in fentanyl-related overdoses. In the Northeast states, Cocaine is the most common stimulant involved with fentanyl in the Northeast, and methamphetamine is the most common stimulant in the Midwest and South, NPR reported.
The first wave of the opioid crisis began in the early 2000s, driven by the overprescribing of opioids, experts told NPR. The second wave began around 2010, driven by increasing heroin use, and the third wave began around 2015, when fentanyl and other synthetic opioids appeared in the drug supply.
It is unclear how often the combined stimulant and fentanyl use driving the fourth wave is intentional, NPR reported. One study indicates that most fentanyl users sometimes take the drug intentionally, and other times unintentionally when it is combined with other drugs.
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