Current Drug Use Trends in the “Fourth Wave” of America’s Overdose Crisis and Among Patients Prescribed Medications for Opioid Use Disorder

Synthetic opioids, primarily illicitly manufactured fentanyl (IMF), remain the driving force behind the overdose epidemic in the U.S.—contributing to more than 68% of the nearly 108,000 drug overdose deaths reported in 2022. Although IMF continues to dominate the national conversation, a substantial and growing number of synthetic opioid overdose deaths now co-involve stimulants (i.e., methamphetamine and cocaine). Thus, the analysis of individual drugs fails to capture the complex patterns of substance use that are more common in real-world settings and the concurrent use of other illicit or non-prescribed substances increases overdose risk and negatively affects treatment outcomes. Urine drug testing (UDT) provides clinically actionable, objective information about drug use to support clinical decision making and aggregated UDT data have shown to significantly and strongly correlate with overdose mortality data reported by the CDC. UDT data complement data from public health and law enforcement agencies to provide more complete and timely information on current drug use trends to help inform clinical practice and community response efforts to reduce overdose deaths. This presentation will provide insight into current drug use trends (i.e., 2023 and 2024), with an emphasis on shifting trends in polysubstance use among people who use fentanyl, from a national database of millions of definitive UDT results derived from patient specimens collected in health care settings, including substance use disorder treatment. It will also describe peer-reviewed research on non-prescribed and illicit drug use among patients prescribed buprenorphine or methadone and how their drug use varies based on MOUD adherence.

Presentation Objectives

  1. Participants will gain an understanding of the relationship between aggregated UDT data and overdose mortality data reported by the CDC
  2. Participants will be able to describe the “fourth wave” of the overdose crisis and current drug and polysubstance use trends among people who use fentanyl at the national, regional, and state levels
  3. Participants will be able to articulate key issues related to continued drug use among individuals receiving medications for opioid use disorder (MOUD)
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