Rx Summit Spotlight: Dual Focus on Opioids and Stimulants Grows Urgent

The two main conclusions of the Emerging Threats Report 2019 from the National Emerging Threats Initiative (NETI) likely will not surprise many who are involved in anti-drug efforts: The trend that fueled the opioid crisis has peaked and should remain in decline, while supply and demand associated with stimulants continue to increase to epidemic proportions.

A more detailed look at the data released last month, however, brings to light some less-discussed nuances of the drug threat reports that guide federal, state and local law enforcement activity in the High Intensity Drug Trafficking Area (HIDTA) program. For example, despite recent declines in new initiates and past-year users of prescription opioids, overall levels of abuse of prescription opioids remain much higher than the corresponding numbers for heroin. The data therefore don't fully support the often-heard conclusion that efforts to limit access to prescription opioids led to a mass migration to heroin.

“There was some replacement, but it was small,” John L. Eadie, MPA, public health and PDMP project coordinator for NETI, tells Addiction Professional. “The premise is not really accurate.”

Likewise, although recent data have found that adverse outcomes associated with methamphetamine are rising faster than those for other stimulants, the report still suggests troubling trends around all three main stimulant categories: meth, cocaine and prescription stimulants.

The report states that “the abuse and misuse of stimulant drugs has been escalating into an epidemic. These are now a major threat to public health and public safety. All levels of government, non-governmental agencies, community groups and professionals need to immediately focus on stimulants while continuing to address the opioid epidemic.”

Conference presentation

Eadie on April 16 will deliver the opening address for a daylong summit on stimulants to be held in conjunction with the April 13-16 Rx Drug Abuse & Heroin Summit in Nashville, Tenn. Also, as part of the Rx Summit agenda, Eadie will share high-level findings on emerging threats for the main conference audience.

“It is very encouraging to see the speed with which federal, state and local organizations are turning their attention to the stimulant problem in addition to opioids,” Eadie says.

In a development that will continue to encourage action on the stimulant front, communities now are able to apply for expanded use of federal funds that have been targeted to address the opioid crisis, in order for them to initiate stimulant-focused efforts.

The data on stimulants certainly confirm the need to focus on developing trends. Cocaine and methamphetamine accounted for 96% of total drug seizures under the HIDTA program in 2018, far exceeding seizures of opioids. Methamphetamine seizures increased from 2011-2018 in all but one of 32 HIDTA regions.

Demand for stimulants also has approached the level for opioids, according to the NETI report. New initiates and past-year users of stimulants had been increasing in the 2011-2017 period but declined in 2018. Leaders will be closely watching the trend in demand for 2019, given that the small 5% increase in meth initiates in 2018 did not reflect the much larger 142% increase in meth seizures that year.

“Based on our research, we should expect a significant surge in abuse of and dependence on meth and overdose deaths due to meth,” Eadie says.

HIDTA opioid seizures increased slightly from 2017-2018 nationally, but heroin seizures in the hard-hit areas of New England and Appalachia declined substantially in 2018. There also has been a downturn in demand for heroin and prescription opioids, with the combined number of past-year users dropping by 23% from 2015-2018.

Fentanyl continues to be the factor that complicates the interpretation of overall trends in drug use, with supply and overdose deaths associated with fentanyl and its analogs still increasing. “Since persons continue to use fentanyl in combination with other opioids and stimulants, the outlook for overdose deaths involving fentanyl appears to be continued increases,” the NETI report states.

Eadie says the surge in stimulant overdose deaths predominantly involves users who have taken stimulants in combination with fentanyl, knowingly or not.

The NETI report characterizes the stimulant threat as being intertwined with the opioid epidemic. Eadie says, however, that he does not expect a similar progression from prescription to illicit drugs as occurred with some opioid users will take place with stimulants.

He does add, though, that subsequent to publication of the NETI report, authorities learned of the existence of a Florida organization prescribing stimulants in a fashion similar to the “pill mill” pain clinics that were at the center of the prescription opioid boom in that state.

The Rx Drug Abuse & Heroin Summit, to be held April 13-16 in Nashville, Tenn., is the annual gathering for stakeholders to discuss what's working in prevention and treatment to address the opioid crisis.