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The so-called 4th wave of the opioid crisis refers to the dramatic rise in the incidence of overdose deaths due to polysubstance use, or use of opioids with cocaine or methamphetamine.  Cocaine and methamphetamine are highly addictive, powerful, and deadly stimulant drugs.  When used together with illicit fentanyl or fentanyl analogues, there is a substantial risk of stimulant-associated overdose deaths.  Specifically, deaths associated with this type of polysubstance use have increased by 20-30% since 2018, faster than the deaths associated with single use of prescription opioids and heroin. 

Drugs go through cycles.  In the 1990s, the United States was in the throes of what was thought to be a peak in the meth epidemic with about half a million Americans using meth at an economic cost reaching $23 billion. In 2005 Congress enacted the Combat Methamphetamine Epidemic Act, regulating the sale of pseudoephedrine and other precursor products used in meth production, which effectively curbed the domestic supply of meth, but had the unintended consequence of increasing the production of meth by Mexican cartels capable of producing the drug at much higher levels of purity and potency. Fast forward to today, with the ready-made drug easy to find on the streets at low cost and high quality. 

Cocaine has a similar history.  By the 1980s and early ‘90s, the sale of “crack” cocaine surged in the US.  Economically, converting powder cocaine into small “rocks” that could be smoked translated into bigger profit.  It was cheap, simple to produce, easy to use. Government efforts to combat the crack cocaine epidemic became known as the “War on Drugs” and was essentially grounded in deterrence theory – the notion that increased legislation and harsher penalties would deter or discourage the use of drugs.  As a consequence, the prison population doubled due to the arrest of drug dealers and their customers. Again, fast forward to today and, like methamphetamine, recent trends in price, purity and availability have been major drivers of increased use and deaths related to cocaine.  Drug potency and death rates go hand in hand. Mixing cocaine with opioids to produce the perfect “high” is a very dangerous practice, which can end up being deadly.

Unlike opioid use disorder, there is no FDA-approved medication to treat methamphetamine or cocaine use disorder.  The most effective treatments available are psychosocial, behavioral or “talking” therapies.  These approaches provide clients with support, while teaching new lifestyle skills to reduce and stop using drugs.  Science has shown that addiction to stimulants is a complex biological, social, and psychological disorder.  Effective treatment needs to be comprehensive and based on stages of recovery – from initial cessation to long-term abstinence.  Researchers at the UTHealth CNRA are studying a treatment approach that combines the latest behavioral interventions to help individuals quit and stay quit from cocaine.

The trial has currently enrolling participants.  For more information, please call 713-500-DRUG (3784) or visit: cnraclinic.com/cocainestudy