Fentanyl-Laced Coke and Meth Is Not Fuelling America's Overdose Crisis

“Overdose deaths from fentanyl-laced cocaine and meth have risen 50-fold,” screamed the Daily Mail about a new study into the US opioid crisis.

The Mail, reporting on the study published last week in the scientific journal Addiction, warned that “many users unwittingly consume fentanyl, as it is frequently used as a cutting agent in cocaine and other illicit drugs to extend the supply and the high”.

Reporting on the same study, carried out by researchers at the University of California, Los Angeles (UCLA), ABC News told its readers: “Many people who use drugs like cocaine recreationally may not be aware these drugs are laced with fentanyl… this could be fueling unintentional overdoses, according to experts.”

But is this really happening?

The UCLA study found that a “fourth wave” of the overdose crisis is being driven by people who had used fentanyl alongside either cocaine or meth. It said the number of these deaths had risen 50-fold since 2010, accounting for nearly a third of over 100,000 drug deaths in 2021, with the highest rates impacting Black people living in the West.

But experts, including the study’s co-author, have told VICE News these media reports are false, and that it is doubtful this new wave of fatal drug overdoses is driven by people accidentally taking cocaine and meth laced with fentanyl.

Instead, the surge in Americans dying after using fentanyl and stimulant drugs is more likely being caused by other factors, such as people purposefully mixing fentanyl and stimulant drugs together for a stronger hit and taking these drugs over the course of the same day.

Chelsea Shover, an assistant professor-in-residence at the David Geffen School of Medicine at UCLA, who co-authored the UCLA study, said claims that the jump in these deaths was down to “fentanyl-laced cocaine” were not one of their conclusions, adding that it was an unlikely scenario.

“If someone died from an overdose where both fentanyl and cocaine were listed in the cause of death field, that doesn't tell us about what the person thought they were taking, or even if they took those drugs at the same time,” said Shover. “Based on my reading of the evidence from both law enforcement seizures and drug checking data, I think that contamination [cocaine and meth containing fentanyl] is rare, in a way that suggests it's usually accidental, for example because a seller used the same scale for multiple products or mixed up baggies of similar-looking powders,” said Shover.

A drug-checking programme Shover and a team of researchers have been carrying out since January in Los Angeles – where meth-related deaths are a far bigger problem than those linked to cocaine – has so far found zero samples of meth laced with fentanyl.

Ever since fentanyl started being pumped into America’s opioid supply in around 2010 by Mexican cartels, a range of media outlets, politicians, law enforcement and health organisations have claimed that cocaine, meth – and even ketamine, MDMA and weed – are being deliberately laced with fentanyl by drug gangs, despite there being little evidence to support these scare stories.

A lot of the confusion around the myth that mainstream supplies of stimulant drugs are being routinely laced with fentanyl is due to the fact that postmortem toxicology tests have found an increasing number of people with fentanyl plus cocaine or meth in their bodies when they died. It has been assumed this means these people took stimulants secretly laced with fentanyl.

Yet as Shover told VICE News, it is well known that people who use opioids such as fentanyl or heroin intentionally mix them with cocaine or meth in speedballs and goofballs for a stronger hit, or they use the two types of drugs at different times of the day. For example opioids are used after bingeing on stimulants to ease the comedown.

The UCLA study said “many individuals” reported mixing a small amount of meth into injected doses of fentanyl because users believe it prolongs the onset of withdrawal symptoms, increases euphoria, decreases overdose risk and improves energy levels required to continue to collect funds for the next set of drug purchases.

The report also noted that the rise in joint fentanyl-stimulant ODs could also be down to the spread of synthetic opioids such as fentanyl into counterfeit opioid and tranquilliser pills resembling oxycodone or alprazolam. This has meant a wider population of people – younger and more likely to use stimulant drugs such as cocaine and meth – are exposed to fentanyl.

There have been some rare but high-profile cases where people have died after taking cocaine which has actually been contaminated with fentanyl. But this contamination is chiefly accidental and most often occurs among people buying at the lower end of the drug market, from corner dealers who are weighing, cutting and packaging opioid and stimulant street deals on the same surface. There have been no documented cases of crime gangs making or trafficking wholesale batches of stimulants laced with fentanyl, or of police seizing large amounts of these mixtures.

Dan Ciccarone, Justine Miner Professor of Addiction Medicine at the University of California San Francisco, and a leading authority on the spread of fentanyl in US drug markets, said most people who die with stimulants and fentanyl in their bodies took both drugs intentionally, rather than by accident.

“Accidental co-use, that is through contaminated drugs, occurs. But it is a relatively minor factor when compared with intentional co-use. The speedball combinations of heroin and fentanyl, and cocaine and methamphetamine, are very common now. This cohort of people is getting increasingly tolerant to the effects of fentanyl and use stimulants to potentiate the fentanyl.”

He called for better analysis of America’s drug supply in order to avoid confusion about which drugs pose the biggest threats. “The anecdotes of dedicated cocaine users who overdosed on fentanyl ring loud, but it would be better to rely on systematic data to judge the size of the problem. My call here is for better, localised, and timely data on the drug supply so we can be more evidence-based moving forward in this public health crisis.”