California Struggles with Increasing Fentanyl-Methamphetamine Overdoses

California, along with other western states, is struggling with a high rate of combined fentanyl-methamphetamine overdoses. This phenomenon is part of what some authorities call the “fourth wave” of the opioid crisis.

The “fourth wave” concept refers to the four different patterns of opioid abuse and overdose that have plagued America since the 1990s.

• First wave: Millions of Americans become addicted to prescription opioids like OxyContin and hydrocodone either because their doctor prescribed it or they used them recreationally.

• Second wave: Many abusers of prescription drugs migrate to heroin from prescription drugs, when doctors refuse to keep prescribing or when the user’s money runs out. In 2010, a revised formulation of OxyContin to make it abuse-resistant aggravated this situation.

• Third wave: Fentanyl arrives on the market, starting out small in 2014 and increasing dramatically over the next few years, followed by a massive increase in overdose deaths. Soon, there is little heroin on the market, but there are millions of counterfeit pills that contain fentanyl.

• Fourth wave: A large number of abusers of opioids are combining their fentanyl or other opioid use with methamphetamine or cocaine.

It was during the third wave that American overdose deaths reached 100,000 in each twelve-month period. It wasn’t until May 2024 that this statistic dipped below 100,000 per twelve-month period for the first time since April 2021.

What the Fourth Wave of the Opioid Crisis Looks Like in California

This chart shows the drugs causing drug overdose deaths in California between June 2019 and June 2024. During the pandemic, these losses that were already trending up began to rise more steeply. The gray line shows overdose deaths involving psychostimulants with abuse potential (mostly methamphetamine), and the brown line shows deaths from synthetic opioids (almost all fentanyl).

• Until August 2021, there were more deaths from psychostimulants than fentanyl. That month, the numbers were almost identical: 6,062 deaths in the prior 12 months from psychostimulants and 6,071 from synthetic opioids. After that, fentanyl deaths outstripped methamphetamine deaths. The total number of drug overdose deaths in the 12 months prior to August 2021 was 11,345.

• A drug-testing company in California reported that among those who tested positive for fentanyl in 2023, 72% also tested positive for methamphetamine. This trend has increased more than 2000% since 2013.

• Also in 2023, 93% of those who tested positive for fentanyl also had a positive result for one or more additional drugs. Tests that were positive for fentanyl were also positive for stimulants more frequently than they were positive for either heroin or prescription opioids.

It could be that these people are purchasing bags or pills that contain more than one kind of drug. However, polydrug abuse—using more than one drug at a time or using different drugs in quick succession—is also extremely common.

It’s important to note that most people who go to the illicit market to get pharmaceutical products generally end up with a fentanyl-laced, counterfeit product. In 2023, more than 80 million fake pills were seized by the Drug Enforcement Administration.

California’s Proximity to Mexico and High Population Make it a Target for Cartels

 

California is in the crosshairs of the drug cartels and the state’s drug seizure statistics reveal the extent of the problem:

• Between January and August 2024, law enforcement seized nearly 5,000 pounds of powdered fentanyl and more than 8.8 million pills at California’s ports of entry. (Note: It only takes two milligrams of pure fentanyl to kill a person who is not used to taking opioids.)

• A single traffic stop in 2024 resulted in a seizure of enough fentanyl to kill a quarter of the state’s population.

• In November 2024, Southern California police arrested 25 members of a drug trafficking gang involved in the sales of methamphetamine, fentanyl, cocaine, and heroin. Twenty-three more members were being sought.

With this volume of trafficking and cartel presence, it is no wonder that California struggles with high losses due to drug abuse. Since May 2021, the state has consistently lost 11,000 or more residents to drug overdoses, annually.

Nationally and in California, Overdose Deaths Peaked in 2023 and Have Been Dropping Since

Along with the rest of the country, California’s overdose deaths peaked in August 2023. In the prior twelve months, there were a total of 13,306 deaths. Deaths from fentanyl in that twelve-month period were 8,293. Deaths involving methamphetamine were 7,310 in the same period. One death can involve more than one drug, explaining why the number of deaths from fentanyl and meth alone exceeds the total number of deaths.

There were also deaths from cocaine, prescription drugs, heroin, and methadone at lower numbers as you can see here.

• Cocaine: 1,702
• Prescription drugs: 775
• Heroin: 280
• Methadone: 202

A Desperate Trend for the State

A study published in 2023 noted that the number of deaths involving both fentanyl and methamphetamine has increased 50-fold since 2010.

Why? Some fentanyl users began adding meth to their drug use to counteract some of the effects of fentanyl that they didn’t like. Other drug users may simply obtain supplies of their preferred drug already contaminated with other drugs.

Always remember that there are far more nonfatal overdoses than fatal ones. In 2021, there were 57,000 emergency room visits for nonfatal overdoses. That year, 10,900 people died from overdoses.

A person who is abusing illicit drugs is living on a razor’s edge. One or two milligrams more of fentanyl in his dose could mean his death. The only safety is sobriety. Yes, it is often a difficult transition from addicted to sober. But this transition would be life-saving for tens of thousands of Americans each year.

Sources:

• “Provisional Drug Overdose Death Counts.” Centers for Disease Control and Prevention, 2024. CDC

• “Methamphetamine Use in California.” Millennium Health, 2024. Millennium Health

• “One Pill Can Kill.” Drug Enforcement Administration, 2024. DEA

• “California’s fentanyl task force seizes over 8.8 million fentanyl pills.” Governor’s Office, 2024. gov.ca

• “Police seize enough fentanyl to ‘kill a quarter of the population of California.’ The Guardian, 2024. The Guardian

• “Forty-Eight Defendants Charged in Imperial Valley Takedown of Drug Trafficking Network Linked to Sinaloa Cartel.” Department of Justice, 2024. DOJ

• “San Francisco faces deadliest year for drug overdoses due to rise of fentanyl.” The Guardian, 2023. The Guardian

• “Statewide Needs Assessment.” California Department of Health Care Services, 2023. DHCS