The Illicit Stimulant Crisis is a Public Health Epidemic Not a Mortality Crisis: Repositioning Overdose Risk Associated with Cocaine & Methamphetamine and the Consequences for Public Health Response

In the past several years, the United States has been witnessing a crisis of mounting opioid overdose deaths involving cocaine and methamphetamine (hereafter illicit stimulants). The scope and impact of this developing crisis have raised alarms that illicit stimulants represent a “4th wave” of the opioid epidemic. Despite this recognition, there remains a paucity of understanding on how the uneven distribution of cocaine and methamphetamine in urban compared with rural areas of the U.S. is contributing to the stratification of drug overdose deaths based on the race and residential location of consumers. This talk will present findings from a recent investigation in Ohio that was conducted to better understand how supply-side trends in illicit drugs contributed to the surge in illicit stimulant-involved deaths from 2014-2019. Findings will demonstrate how the growing problem of illicit stimulants is not a homogenous crisis but one exhibiting racial and geographic variation at the point of both supply and consumption. These findings will argue for the need to tailor prevention messaging and interventions to the race and residence of illicit stimulant consumers and local trends in the illicit drug supply. By deepening our understanding how race, urbanicity, and illicit supply chains intersect to generate locally specific risk environments, this presentation will advance public health response by putting federal and state agencies in a better position to respond more effectively to the health needs of urban and non-urban residents alike.