‘Fourth wave’ of opioid epidemic: Older adult deaths by fentanyl also show stimulant use – Georgia Public Broadcasting

Report on the Fourth Wave of the Opioid Epidemic: Polysubstance Use and its Impact on Sustainable Development Goals

Executive Summary

An emerging trend in the opioid epidemic, identified as the “fourth wave,” reveals a significant increase in polysubstance use, specifically the co-involvement of stimulants in fentanyl-related overdose deaths. This report analyzes this trend, with a particular focus on the older adult population (65 and over), and evaluates its profound implications for the achievement of the United Nations Sustainable Development Goals (SDGs), primarily SDG 3 (Good Health and Well-being).

Key Findings on Polysubstance Overdose Trends

Data indicates a critical shift in the nature of fatal overdoses, challenging existing public health strategies. The primary findings are as follows:

• Escalating Polysubstance Fatalities: The proportion of fentanyl-related deaths among individuals aged 65 and over that also involved a stimulant has risen dramatically.
• Statistical Increase: In 2015, approximately 9% of such fatalities involved a stimulant. By 2023, this figure had surged to nearly 50%.
• Prevalent Stimulants: Cocaine is the most commonly identified stimulant in these polysubstance overdose cases.
• Demographic Convergence: This pattern of combined opioid and stimulant use in older adults mirrors trends previously observed in younger populations, indicating a widespread public health crisis that transcends age demographics.

Implications for Sustainable Development Goals

The opioid crisis, particularly this fourth wave of polysubstance use, presents a direct threat to several SDGs. The failure to address this crisis undermines global progress towards a sustainable and equitable future.

1. SDG 3: Good Health and Well-being

   This goal is the most severely impacted. The rising overdose mortality rate is in direct opposition to Target 3.5, which calls for strengthening the prevention and treatment of substance abuse. The epidemic’s effect on older adults underscores a failure to ensure healthy lives and promote well-being for all at all ages.

2. SDG 10: Reduced Inequalities

   The crisis exacerbates health inequalities. Older adults may face unique barriers to accessing substance use disorder treatment, mental health services, and harm reduction resources. Addressing this demographic’s specific needs is crucial to ensuring equitable health outcomes and reducing inequalities within and among countries.

3. SDG 16: Peace, Justice, and Strong Institutions

   The prevalence of illicit substances like fentanyl and cocaine points to the challenge of combating organized crime and illicit trafficking, a key component of SDG 16. Stronger institutions and international cooperation are required to disrupt the supply chains that fuel this public health emergency and threaten community safety.

Recommendations for an SDG-Aligned Response

To mitigate the impacts of the opioid crisis and realign efforts with the SDGs, the following actions are recommended:

• Integrate Health Services (SDG 3): Develop and fund integrated healthcare models that combine primary care, mental health support, and substance use treatment, tailored to the complex needs of older adults.
• Enhance Data Monitoring (SDG 3 & 16): Invest in robust, real-time data collection systems to track polysubstance use trends across all age groups to inform targeted public health interventions and law enforcement strategies.
• Targeted Prevention and Education (SDG 3 & 10): Launch public awareness campaigns specifically designed for older adults and their caregivers about the risks of polysubstance use, thereby reducing health inequalities through accessible information.
• Strengthen Community Support Systems (SDG 11): Bolster community-based organizations that provide harm reduction services, treatment navigation, and recovery support to create safer, more resilient, and healthier communities.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The article directly addresses public health crises, specifically the opioid epidemic and its impact on mortality. It discusses “fentanyl deaths,” “overdose deaths,” and “substance use disorder,” which are all critical concerns for ensuring healthy lives and promoting well-being for all ages, as outlined in SDG 3. The focus on a specific demographic, “older adults,” underscores the goal’s principle of inclusivity across all age groups.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

   • This target is the most relevant as the article’s core subject is the “fourth wave of the opioid epidemic.” It explicitly details the consequences of narcotic drug abuse through its analysis of deaths involving fentanyl and stimulants like cocaine. The rising mortality rates imply significant challenges in the prevention and treatment of substance abuse, which this target aims to address.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Yes, the article implies specific indicators that can measure the severity of the substance abuse problem and track progress toward Target 3.5.

   • Mortality rate from drug overdose: The article is centered on “fentanyl-related deaths” and “overdose deaths.” The number and rate of these deaths are direct measures of the negative outcomes of substance abuse, serving as a key indicator of the effectiveness of prevention and treatment efforts.
   • Prevalence of polysubstance use in overdose deaths: The article provides precise data points that function as an indicator of the changing nature of the drug crisis. It states, “In 2015, about 9% of fentanyl-related deaths among people 65 and over also included a stimulant. By 2023 nearly half did, most commonly cocaine.” Tracking this percentage is a specific way to measure the complexity and evolution of substance abuse patterns.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: gpb.org