DOI: https://doi.org/10.36347/sjams.2025.v13i06.008

Pages: 1283-1293

As the opioid epidemic continues to evolve in the U.S., so do the drug mixtures. For instance, the use of synthetic opioids in combination with other drugs, such as stimulants and other opioids, has taken off. This presentation will provide epidemiologic and toxicological data on new and evolving mixed-drug overdose trends, including cocaine and methamphetamine being mixed with fentanyl, and the emergence of nitazenes worldwide. In addition, we will discuss how investigators can use clinical data for surveillance of drug overdose trends with a specific focus on drug mixtures. Finally, we will discuss next steps and the need for a multi-disciplinary approach to tackle emerging trends in mixed-drug overdoses. On March 2, 2023, the CDC reported that cocaine was involved in 38.2% of overdose deaths and methamphetamine was involved in 24.8% of overdose deaths in the U.S. in 2021. In the western region of the U.S., 68.9% of methamphetamine-involved overdose deaths also involved cocaine combined with fentanyl. Here, we highlight public health surveillance efforts to quantify and characterize cocaine and methamphetamine mixed with fentanyl overdose deaths using death certificate and toxicologic data from Nevada. Among the 300 overdose deaths in 2021, the drugs involved in these deaths were cocaine alone, cocaine and methamphetamine, cocaine mixed with fentanyl, and cocaine and methamphetamine mixed with fentanyl. Toxicological data indicated that 87% of the decedents with cocaine mixed with fentanyl had a positive toxicology result for fentanyl.