Unveiling the Future of Substance Abuse: Beyond the Opioid Crisis

 

Unveiling the Future of Substance Abuse: Beyond the Opioid Crisis

The opioid crisis continues to be a pressing issue in the United States, but there are glimmers of hope on the horizon. Overdose deaths linked to opioids are stabilizing in some areas and decreasing in others. Increased awareness of the perils of opioid misuse is taking root, and more than $50 billion in opioid settlement funds are finally reaching state and local governments after years of delays. However, even as we make progress, it's crucial to recognize that certain challenges may persist. The opioid crisis, like public health emergencies of the past, will eventually ebb, but what comes next?

One inescapable reality is that synthetic opioids such as fentanyl will likely remain a part of the illicit drug landscape. Their potency, addictiveness, and profitability make them incredibly resilient. Opioids, akin to other enduring public health challenges, will continue to circulate in communities, albeit at more manageable levels.

What is more concerning, though, is what might replace opioids. Since 2010, overdoses involving both stimulants and fentanyl have surged exponentially, signaling a potential "fourth wave" in the opioid crisis. However, could this wave actually mark the beginning of a new stimulant crisis?

Patterns in substance abuse tend to be cyclical. Periods marked by high usage of depressant drugs like opioids are often succeeded by surges in stimulant drug use, such as methamphetamine and cocaine, and vice versa. The historical trajectory of drug trends suggests that the previous generation's preferences are often rejected by the next. What sets this era apart is the prominence of synthetic drugs—illicit substances engineered in labs to mimic the effects of naturally occurring drugs.

Today, with a few thousand dollars and internet access, individuals can find instructions to establish their small-scale drug operations. While the TV series "Breaking Bad" was fictional, it is no longer far-fetched to envision such scenarios in the age of synthetic drugs.

In the real world, methamphetamine has become a significant concern. From 2015 to 2019, overdose deaths linked to methamphetamine nearly tripled, primarily due to its combination with fentanyl. Yet, cocaine, America's favored illicit stimulant, continues to outpace methamphetamine. In the most recent National Survey on Drug Use and Health, more adults aged 18 or older reported using cocaine compared to methamphetamine.

Over the past decade, illicit drug manufacturers have synthesized over 1,200 new psychoactive substances.

Cocaine enjoys a unique place in American pop culture, often associated with celebrities, lawyers, and finance professionals. Its sale and use have been romanticized in music, TV, and cinema. However, the harsh reality is that, in the year leading up to April 2023, more than 27,000 Americans died while using cocaine, according to provisional statistics from the U.S. Centers for Disease Control and Prevention.

The majority of cocaine production currently occurs in Colombia, Peru, and Bolivia due to favorable climates and cultural ties to the coca plant. But what if cocaine or a similar substance could be manufactured anywhere?

This idea is not new. Over the past decade, illicit chemists have synthesized over 1,200 new psychoactive substances (NPS), also known as designer drugs or research chemicals, in pursuit of more potent highs. While none of these lab-made drugs have threatened cocaine's dominance thus far, advancements in artificial intelligence, synthetic biology, and biotechnology could change that.

In Europe, authorities recently raised concerns about counterfeit Captagon, an amphetamine-like drug with physiological effects similar to cocaine. Commonly referred to as "poor man's cocaine," Captagon is immensely popular in the Middle East, where it can be purchased for as little as $3 per pill and fuels the party scene. It's important to note that Captagon pills today are mostly counterfeit, containing various dangerous substances, including fenethylline, amphetamine, methamphetamine, and caffeine.

Captagon shares similarities with counterfeit oxycodone pills in the U.S. Both are advertised as one substance but contain another. Because they are in pill form, they are more appealing to the average drug consumer, who associates pills with legitimate prescription medications.

While synthetic opioids like fentanyl currently account for most drug overdose deaths, cocaine and methamphetamine carry substantial risks of their own. Stimulants place immense strain on the body's cardiovascular system, increasing the risk of heart attacks, strokes, and fatalities. Unlike opioids, there is no miracle overdose reversal drug like naloxone for stimulants, nor are there medication-assisted treatments for stimulant use disorders.

Surprisingly, the U.S. Drug Enforcement Administration did not increase annual production quotas for several amphetamine-based prescription medications, like Adderall and Ritalin, in late 2022, despite concerns about shortages raised by drug manufacturers. The agency's decision partly stemmed from fears that aggressive marketing could trigger the next crisis. Although recent studies suggest that young adults using ADHD medications are not necessarily inclined to use illicit drugs in the future, the question remains whether users will turn to the black market if shortages persist, as occurred with prescription opioids.

The illicit drug trade is regionally specific, and preferences shift. Just because a substance gains popularity in one part of the world does not guarantee its appeal elsewhere. Nevertheless, Captagon possesses the characteristics of a potential next big threat for the American public. Like fentanyl, it has a built-in user base, is cost-effective to produce, and is highly addictive. Unlike some other synthetic drugs, Captagon avoids bizarre side effects, making it a concerning prospect.

Predicting the form of the next drug crisis is challenging, but one thing is certain: another crisis will emerge. Early warnings and vigilant monitoring are crucial to identify and address new threats promptly. Public health and law enforcement organizations must improve data collection and intelligence gathering to detect emerging drug challenges. Collaboration across prevention, supply reduction, and treatment sectors is essential. The U.S. and its allies must act proactively to prevent the repetition of past mistakes before it's too late.