5th Edition of Addiction World Conference 2026

Abstract

America’s overdose epidemic is complex and has been broadly described as consisting of three “waves” of overdose deaths involving prescription opioids (Wave 1), heroin (Wave 2), and fentanyl (Wave 3).  From 2013 to 2021, the number of fentanyl involved overdose deaths increased 84-fold, totaling nearly 261,000 lives lost.  However, non-opioid drugs are also frequently involved in fatal opioid overdoses and our understanding of how polysubstance use impacts overdose vulnerability and treatment responses remain relatively limited.  More recently, a “fourth wave” of drug overdose deaths involving fentanyl and stimulants (i.e. methamphetamine and/or cocaine) has emerged.  In 2010, stimulant-fentanyl co-involved in less than 1% of fentanyl overdose deaths nationally.  By 2021, stimulant-fentanyl co-involvement had grown, accounting for nearly one third (32.3%) of all fatal fentanyl overdoses.  To better address a growing and ever-changing overdose epidemic, timely sources of data that provide detailed insight into current drug use trends are needed.  Urine drug test (UDT) data have shown to significantly correlate with national overdose mortality patterns over time and may offer particularly relevant information on shifting drug use trends that correspond with the evolving nature of the overdose crisis.  Because UDT data update rapidly (i.e. daily), they can inform responses to address the fentanyl crisis and help save lives.  Therefore, these data warrant thoughtful consideration.  This presentation will illustrate that UDT results tightly correlate with trends in fentanyl-related overdose mortality, explore changes in the co-detection of prescription opioids, heroin, methamphetamine, and cocaine, in fentanyl-positive specimens, and provide insight into recent trends in polysubstance use among people who use fentanyl.