INTRODUCTION

Fentanyl-related deaths involving stimulants have increased in the U.S., but little is known about nonfatal overdoses involving use. This study examined national trends in nonfatal fentanyl-related exposures involving co-use of cocaine or methamphetamine.

METHODS

In this cross-sectional analysis, data from U.S. poison centers were used to estimate annual trends in reported exposures involving fentanyl and stimulant use from 2015 to 2023. Cases included patients aged ≥13 with exposures involving intentional misuse or "abuse" of fentanyl where nonfatal adverse effects occurred (n=13,173). Co-exposure trends were examined, and multivariable logistic regression models were used to estimate how region and medical outcome severity were associated with (1) fentanyl-cocaine use (versus fentanyl, no cocaine use) and (2) fentanyl-methamphetamine use (versus fentanyl, no methamphetamine use).

RESULTS

Between 2015 and 2023, among fentanyl-related exposures, cocaine use increased from 1.3% to 10.0% (669.2% increase, p<0.001) and methamphetamine use increased from 1.5% to 10.8% (620.0% increase, p<0.001). Exposures in the Northeast were associated with higher odds of cocaine co-use, while exposures in the Midwest, South, and West were associated with higher odds of methamphetamine co-use. Compared to those with less severe effects, those with a major (life-threatening) effect had higher odds of cocaine co-use, but lower odds of methamphetamine co-use.

CONCLUSIONS

Similar to drug-related mortality trends, nonfatal fentanyl poisonings involving co-use of cocaine or methamphetamine increased in recent years and became increasingly widespread. Differences in experience of life-threatening adverse effects linked to different stimulants suggests varying risk according to which stimulant is involved.