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description Monograph

It Is No Longer Just an Opioid Problem: Polysubstance Misuse and the Fourth Wave of the Overdose Crisis

Target Audience: Pharmacist, Physician Assistant, Physician

schedule 3.00 Contact Hours (0.30 CEUs)
category Disease State Management/Drug Therapy
local_activity Application

Course Overview

The drug overdose crisis in the United States began in the 1990s. This crisis was fueled by a growth in opioid prescriptions by healthcare providers and is referred to as the "first wave." The first wave was followed by a second wave, driven by a rise in heroin use. A third wave followed, which was highlighted by the use of synthetic opioids. Now, a fourth wave has emerged in the opioid overdose crisis. This wave is marked by polysubstance misuse involving opioids (primarily fentanyl) combined with stimulants. These waves have caused a progressively higher number of drug overdose deaths in the United States. However, since late 2023, overdose deaths have steadily declined each month—a strong sign that public health interventions are making a difference and having a meaningful impact. This activity reviews the distinctive features of each wave of the drug overdose crisis, the increasing role of polysubstance misuse in the fourth wave, the emergence of novel substances, and the differences when assessing, diagnosing, and treating opioid and stimulant overdoses and use disorders.

Learning Objectives

Upon completion of this educational activity, participants should be able to:

  • Explain how polydrug misuse has become the dominant factor in overdose deaths
  • Discuss the characteristics and health consequences associated with stimulant misuse
  • Apply evidence-based strategies for assessing patients with opioid and stimulant use disorders
  • Discuss the treatment differences between opioid and stimulant use disorders

Faculty

Authors & Activity Planners
Abimbola Farinde, PhD., PharmD
View Bio +
Abimbola Farinde, PhD., PharmD is a healthcare professional and professor who has gained experience in the field and practice of mental health, geriatrics, and pharmacy. She has worked with active duty soldiers with dual diagnoses of a traumatic brain injury and a psychiatric disorder providing medication therapy management and disease state management. Dr. Farinde has also worked with mentally impaired and developmentally disabled individuals at a state supported living center. Her different practice experiences have allowed her to develop and enhance her clinical and medical writing skills over the years. Dr. Farinde always strives to maintain a commitment towards achieving professional growth as she transitions from one phase of her career to the next.
Anna Shurtleff Smith, MPH, BSN-RN
View Bio +
Anna Shurtleff Smith is a graduate of the University of North Texas Health Science Center, School of Public Health with a community health focus, and Texas Tech University School of Nursing. She has clinical experience in both inpatient and outpatient settings. Anna is passionate about patient education, health literacy, and health communications. When not writing, she can be found enjoying the outdoors and enjoying family time.
Additional Faculty & Reviewers
Pamela Sardo, Pharm.D., B.S.
View Bio +
Pamela Sardo, Pharm.D., B.S. is a licensed pharmacist and Freelance Medical Writer at Sardo Solutions in Texas.
L. Austin Fredrickson, MD, FACP
View Bio +
Dr. Fredrickson is an assistant professor of internal medicine at Northeast Ohio Medical University, where he serves as core faculty and teaches diagnostics, therapeutics, clinical skills, and health humanities. He is board-certified in general internal medicine and practices rural primary care.
  • Introduction
  • The First Three Waves of the Drug Overdose Crisis
    • The First Wave: Prescription Opioids
    • The Second Wave: Heroin
    • The Third Wave: Synthetic Opioids
  • The Fourth Wave: Polysubstance Misuse
    • Racial and Regional Disparities
    • Risk Factors for Opioid and Stimulant Use Disorders
  • Multiple Substance Use
    • Psychostimulants and Opioids
    • Stimulants and Heroin
    • Methamphetamine and Fentanyl Use
    • Cocaine and Opioids
    • Emerging High-Risk Combinations
  • Prevalence of Drug Overdose
  • Effects of Co-Using Opioids and Stimulants
  • Healthcare Team's Role in Combatting the Overdose Crisis
    • Diagnosing OUDs or StUDs
    • Diagnosing Opioid Intoxication
    • Diagnosing Stimulant Intoxication
    • Co-Prescribing Naloxone
    • Suspected Overdose
  • Case Report
  • Treatments for Opioid and Stimulant Use Disorders
    • Treatment Regimens for OUDs
    • Treatment Regimens for StUDs
  • Patient Case
  • Summary and Key Points

From May 24, 2026 through May 24, 2029, participants must:

  1. Read the "learning objectives" and "author and planning team disclosures"
  2. Study the section entitled "educational activity"
  3. Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Credit for this course will be automatically uploaded to CPE Monitor®.

Faculty Planner Disclosure

The following individuals were involved in planning, developing, and/or authoring this activity: L. Austin Fredrickson, MD, FACP; Gerald Gianutsos, PhD, JD; Anna Shurtleff Smith, MPH, BSN-RN; and Pamela Sardo, PharmD, BS. None of the individuals involved in developing this activity has a conflict of interest or financial relationships related to the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.

Unlabeled Use Disclosure

The information provided in this course is general in nature, and it is designed solely to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant's professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice. Healthcare professionals must consult their employer, healthcare facility, hospital, or other organization for guidelines, protocols, and procedures to follow. The information provided in this course does not replace those guidelines, protocols, and procedures, but is for academic purposes only, and this course's limited purpose is for the completion of continuing education credits. Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses is constantly changing. Any person taking this course understands that such a person must make an independent review of medication information before any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby. Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course or course material.

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Accreditation

In support of improving patient care, RxCE.com is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.