Healthcare, opioid epidemic and drug abuse concept with the map of USA filled with oxycodone and hydrocodone pharmaceutical pills on the American flag

(© Victor Moussa -

CHICAGO — A dire new study predicts that America’s opioid epidemic is about to get much worse. Researchers from Northwestern Medicine say the coming fourth wave of opioid overdoses “will be worse than it’s ever been before.”

Using a COVID-19 prediction model to determine where opioid-involved deaths will increase, researchers warn the coming wave will not discriminate geographically. Researchers predict there will be dramatic increases in opioid overdose deaths from the most rural to the most urban counties across the U.S.

For the study, researchers analyzed geographic trends in opioid-involved overdose deaths between 1999 and 2020 to find out if geography played a role in the first three waves and hypothetical fourth wave of the country’s opioid crisis. Researchers examined data of 3,147 counties and county equivalents categorized on a six-point urbanity scale — from most urban to most rural. The data came from the Centers for Disease Control and Prevention’s WONDER database.

“I’m sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county,” says corresponding author Lori Post, director of the Buehler Center for Health Policy and Economics at Northwestern’s Feinberg School of Medicine, in a university release. “Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high.”

Researchers say this is the first time a study examined opioid-involved overdose deaths geographically for every year. The study discovered that overdose deaths in rural areas were surging faster than in urban areas. Post says that between 2019 and 2020, “rates of opioid overdose deaths converged while escalating for the first time across six types of rural and urban counties.”

opioid overdose waves
(Credit: Northwestern University)

Americans are taking drugs more powerful than fentanyl

Opioid deaths have reached this critical mass because users have been combining synthetic opioids with stimulants such as cocaine and methamphetamines.

“We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before,” notes Post. “It’s going to mean mass death.”

Toxicology reports reveal people are using fentanyl and carfentanil, combined with methamphetamines and cocaine. Fentanyl is a synthetic opioid that is 50 to 100 times more powerful than morphine. Even worse, carfentanil is a synthetic opioid 100 times more potent than fentanyl. Researchers add naloxone doesn’t work on reviving people from this lethal cocktail.

“The stronger the drugs, the harder it is to revive a person,” explains study co-author Alexander Lundberg, assistant professor of emergency medicine at Feinberg. “The polysubstance use complicates an already dire situation.”

Post warns it’s a massive problem when users “play pharmacist.”

“It appears that those who have died from opioid overdoses had been playing pharmacist and trying to manage their own dosing,” says Post. “This is a bigger problem because you have people misusing cocaine and methamphetamines along with an opioid, so you have to treat two things at once, and the fentanyl is horribly volatile.”

To help treat addicts, Post says more methadone or buprenorphine centers need to open, particularly in rural areas that have no medication-assisted treatment options.

“The only path forward is to increase awareness to prevent opioid use disorders and to provide medication-assisted treatment that is culturally appropriate and non-stigmatizing in rural communities,” the study author concludes.

The study is published in the journal JAMA Network Open.

About Matt Higgins

Matt Higgins worked in national and local news for 15 years. He started out as an overnight production assistant at Fox News Radio in 2007 and ended in 2021 as the Digital Managing Editor at CBS Philadelphia. Following his news career, he spent one year in the automotive industry as a Digital Platforms Content Specialist contractor with Subaru of America and is currently a freelance writer and editor for StudyFinds. Matt believes in facts, science and Philadelphia sports teams crushing his soul.

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