Key points
Fentanyl in counterfeit pills or smoked alone or with methamphetamine are changing the overdose epidemic.
Inexperienced (low-tolerance) fentanyl smokers, users or speedballers, are at high risk of overdose.
Pre-existing Depression, COVID, heart disease, and liver disease lead to a greater risk of overdose death.
Prevention and education are needed while NIDA supports developing vaccines and new medications.
The last heroin epidemic in the ‘70s and early ‘80s led to speedballing (combining heroin with cocaine). Freebasing was an alternative to intravenous use and its associated needle risks. It was replaced by crack cocaine, which was easier to mass-produce and distribute. The current epidemic started with prescription opioids and moved to heroin, then fentanyl, and lastly, speedballing. Fentanyl has flooded the U.S. and is extremely cheap — $10/gram. This new smoking overdose risk is moving from San Francisco throughout the rest of the country.
This new phase of the opioid overdose crisis focuses on young naïve users. They are sold fentanyl-laced opioid-pain pills, counterfeit Adderall , and other drugs attached to a Trojan horse of fentanyl. As for vapers and smokers, they speedball fentanyl with methamphetamine via fentanyl smoking. Difficulty injecting, fear of needles, hepatitis, and HIV risks, as well as fear of overdose, seemingly motivated this transition from injecting to smoking. Smoking encourages inhalation of large doses of fentanyl — approximately 50 mg of pure fentanyl per day.
When we studied crack, intranasal cocaine, and intravenous use of cocaine in the 1980s, we were surprised to discover smoking was equivalent to injection in speed to the brain. Taking pills orally has the slowest response but most users want to experience the drug’s effects as quickly as possible. Users may mistakenly believe they are “safe” from overdoses if they smoke drugs like fentanyl. Younger needle-adverse new users have learned to smoke and vape and are less fearful of smoking fentanyl. However, it is still very possible to overdose as smoking fentanyl today often means higher doses, plus smoking the previous smoker’s drugs piggy-backed, including fentanyl and meth residues.
Experts are concerned about more fentanyl overdoses among new smokers of fentanyl as the […]
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