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.
Trends in nonfatal fentanyl exposures involving stimulants in the United States, 2015-2023
American Journal of Preventive Medicine, 69, 107742. doi: 10.1016/j.amepre.2025.107742.