The opioid epidemic has dominated headlines, public health initiatives, and billions of dollars in federal funding over the past decade. Yet opioids are not the only substances fueling the overdose crisis in America. Cocaine and methamphetamine—two drugs that often receive less attention—are increasingly responsible for a devastating rise in deaths. In some regions, particularly in the western United States, meth overdoses have even surpassed opioid-related fatalities.
This troubling trend is not new, but it is intensifying. Understanding the scope of cocaine and methamphetamine overdoses, as well as the systemic challenges in addressing them, is critical for developing effective strategies that address the nation’s broader substance use crisis.
A Growing Threat Beyond Opioids
According to the Centers for Disease Control and Prevention (CDC), opioids such as fentanyl, heroin, and prescription painkillers were involved in over 67% of overdose deaths nationwide in 2017. While these numbers remain staggering, cocaine and methamphetamine were the next most commonly implicated drugs, together contributing to tens of thousands of deaths.
The CDC’s 2017 data revealed:
- Cocaine was involved in about 20% of all overdose deaths nationwide.
- Psychostimulants like methamphetamine and ecstasy were involved in 14% of overdoses.
- Cocaine overdose deaths increased 34% from the previous year, killing nearly 14,000 people.
- Psychostimulant-related deaths increased 37%, totaling more than 10,000 lives lost.
Perhaps most strikingly, in western states, methamphetamine has been responsible for more overdose deaths than opioids such as fentanyl. This regional distinction underscores the importance of tailoring prevention and treatment approaches to local drug use patterns, rather than applying a one-size-fits-all strategy.
Polysubstance Use: A Dangerous Combination
Part of what makes cocaine and methamphetamine overdoses so deadly is their frequent combination with other substances, particularly opioids. Cocaine and meth are often laced with fentanyl, sometimes without the user’s knowledge. This creates a lethal mix of stimulants and depressants that drastically increases the risk of overdose.
Polysubstance use is becoming the norm rather than the exception. People struggling with addiction may use multiple drugs simultaneously, whether intentionally or unknowingly. This complicates both treatment strategies and public health interventions, since traditional funding streams and treatment programs often focus on single substances.
Federal Funding Disparities
One of the key barriers to addressing cocaine and meth overdoses is the way funding is distributed. Over the past several years, the federal government has poured billions of dollars into combating opioid addiction, while comparatively little has gone toward addressing stimulant-related crises.
Between fiscal years 2017 and 2018 alone, nearly $11 billion was allocated for opioid-specific programs and projects. In 2018, opioid funding surged 124%, rising to $7.4 billion from $3.3 billion the year prior. While these funds have helped expand medication-assisted treatment (MAT), naloxone distribution, and prevention programs for opioid misuse, they have done little to address stimulant use.
Brooke Feldman, manager of the Philadelphia CleanSlate Outpatient Addiction Medicine center, spoke candidly about this issue at the Payer’s Behavioral Health Management and Policy Summit in Washington, D.C. She explained that many communities cannot access federal funding to address cocaine or meth use because most grants and programs are opioid-exclusive.
“I worked with a community in Texas that got some of the SAMHSA state targeted response (STR) dollars that couldn’t find people who use opioids,” Feldman recalled. “There was a referring coach that told me she just resorted to asking people, ‘Have you ever taken a Percocet?’ so she could provide services under those STR dollars.”
This highlights a systemic problem: by restricting funding to opioid-related programs, other forms of substance use are neglected—even when overdose numbers show they are just as deadly.
The Need for a Broader Narrative
Much of the public conversation around addiction has framed opioid users as victims of overprescribing, fueling sympathy and large-scale intervention. While opioids absolutely deserve focused attention, limiting the discussion to one substance risks overlooking the bigger picture of America’s addiction crisis.
“We need to stop talking about opioids,” Feldman argued. “We need to stop with [only having] opioid initiatives and councils. We have never had only an opioid crisis.”
Indeed, the rise of cocaine and meth overdoses demonstrates that addiction in the U.S. is not tied to a single drug. Shifting the narrative away from “the opioid epidemic” toward a more inclusive framework of substance use disorder could help ensure that resources, policies, and treatment options better reflect reality.
Regional Variations in Substance Use
Another important factor is geography. Substance use trends vary widely across the United States, and what may be true in one region doesn’t necessarily apply to another. For instance:
- The Northeast continues to struggle heavily with fentanyl, which is increasingly present in heroin and counterfeit pills.
- The West faces rising methamphetamine use, with meth surpassing opioids as the leading cause of overdose in several states.
- Urban centers often experience higher rates of cocaine use, while rural communities may see more methamphetamine use.
Recognizing these regional differences is essential for tailoring interventions. A uniform approach risks wasting resources on solutions that don’t fit local needs.
Treatment Barriers and Opportunities
Treating stimulant use disorder presents unique challenges compared to opioids. While medications like buprenorphine and methadone have been proven effective for opioid addiction, there are currently no FDA-approved medications for cocaine or methamphetamine use disorder. Treatment instead relies on behavioral therapies such as cognitive behavioral therapy (CBT) and contingency management.
Contingency management, which uses motivational incentives such as vouchers or small cash rewards for drug-free urine screens, has shown promise in helping people reduce stimulant use. However, implementation is limited due to funding and regulatory restrictions. Expanding access to evidence-based behavioral interventions, as well as continuing research into potential pharmacological treatments, is vital to addressing the stimulant crisis.
Leveraging the Opioid Response for Broader Change
While it is clear that cocaine and meth overdoses need more attention, there is also an opportunity to build on the momentum of the opioid response. The infrastructure developed to combat opioid addiction—such as expanded treatment facilities, harm reduction programs, and public awareness campaigns—could be adapted to address all forms of substance use disorder.
“The opioid epidemic, false narrative and all, is bringing more attention and resources that were desperately needed,” Feldman noted. “If we’re strategic and intentional, we can leverage those to address all substance use disorders.”
By reframing addiction as a universal health issue, rather than one defined by a single drug, policymakers and providers can ensure that resources are distributed more equitably and effectively.
Conclusion
Cocaine and methamphetamine overdoses are rising at alarming rates, even as the nation focuses heavily on opioids. In some areas, stimulant-related deaths now outpace those caused by fentanyl or heroin, making it clear that America’s addiction crisis is multifaceted and ever-evolving.
Addressing this crisis requires a shift in both funding and public perception. Federal dollars should not be restricted to opioid initiatives alone, but instead applied broadly to all forms of substance use disorder. Treatment approaches must also account for regional differences and the unique challenges of stimulant addiction.
Ultimately, if America is to truly curb overdose deaths, it must move beyond the narrow framework of the “opioid epidemic” and recognize the wider substance use crisis for what it is—a complex, nationwide public health emergency that demands comprehensive, inclusive solutions.
