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Unraveling the Twin Epidemic · Talking FACS

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  Welcome to Talking FACS, what you need to know about family,
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  food, finance, and fitness.
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  This nationally recognized, award-winning podcast is hosted by the University
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  of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello, and welcome to Talking FACS, what you need to know about family,
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  food, finance, and fitness.
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  I am your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences Extension at the University of Kentucky.
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  We are housed in the Martin-Gatton College of Agriculture, Food, and Environment.
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  On the news and across social platforms, we are seeing lots of chatter about opioid use and overuse.
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  But while these drugs act to depress or sedate the user, there is increasing
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  concern about the heightened use of stimulants.
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  My guest today, our Extension Specialist for Substance Use Prevention and Recovery, Dr.
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  Alex Elswick, is here to share with us about the emerging twin epidemic.
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  Welcome, Alex. Good morning, Mindy. Thanks for having me.
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  So, what do we mean by the twin epidemic?
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  Yeah, it sounds kind of dark and morbid, doesn't it? And it is.
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  So your introduction was great. You've heard a lot about the opioid epidemic
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  and kind of the context for that.
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  It rages on. Don't think otherwise. I think in our latest overdose fatality
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  report in Kentucky, like 78% of overdoses involved fentanyl.
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  So that's still driving overdoses. but there's this emerging epidemic that some
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  people call a twin epidemic and some people call a silent epidemic because we're
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  really not talking enough about it, and that is emerging trends around stimulant use.
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  So if you look nationally, stimulant use among people who use opioids in particular is crippled.
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  From 2015 to 2017. And so that's smack dab in the middle of this opioid crisis.
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  And yet kind of curiously, all of a sudden we're seeing this huge increase in stimulant use.
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  And then specifically in Kentucky, if you go back to that overdose fatality
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  report, you find that 55% of overdoses included methamphetamine and like 21% included cocaine.
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  And so you do a little bit of arithmetic and you add those together,
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  you get about 76% of overdoses in Kentucky involved the stimulant,
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  which is almost the same number as we just said for fentanyl.
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  So it just makes the case that now stimulants are becoming an increasing driver
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  of the morbidity and mortality, the harm and the death associated with substance use disorder.
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  An interesting kind of related trend there is now new data suggests kind of at the end of 2022.
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  Smoking became the primary, what we would call, route of administration,
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  basically the way of taking a drug that's led to overdose.
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  And so we hear a lot about injection drug use and still should because it's still common.
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  But in part because of this stimulant epidemic, smoking has now surpassed injection
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  drug use as the leading cause of overdose deaths.
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  So it's just this dynamic, constantly changing trends around drug use that's
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  really complicating our ability to respond.
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  Do you think that that's because it's a little bit more socially acceptable
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  to puff it out than it is to kind of inject it?
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  I think definitely. There's actually research to back up kind of what you're
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  saying there, and also research that would suggest that people who use drugs
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  perceive, and probably rightfully so in some respects,
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  perceive less harm from smoking a drug than from injecting a drug on kind of a qualitative basis.
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  Like through COVID, we heard some people who use drugs talk about intentionally
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  switching from opioids, from injecting opioids to smoking stimulants because
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  they perceived it would be safer.
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  Which unfortunately, because of what we're seeing, that may not be the gays.
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  We're seeing more death associated with stimulants.
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  So, and do we see this trend of people taking depressants to help them sleep
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  and then stimulants to help them stay awake so they get in this cycle of taking
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  one and then the other and one and then the other and kind of not being able
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  to get out of the rat race, I guess.
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  Right. That's a common pattern around drug use. And honestly,
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  an even more common pattern of poly drug use is called speedballing,
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  which is using a depressant and a stimulant at the same time.
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  The most pragmatic way to think about it is if you've used a depressant,
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  it can make you sleepy, it can make you drowsy. And so you don't want to fall asleep.
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  You've worked, hustled all day to come up with $15 to afford whatever you're using.
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  You don't want to fall asleep on it. And so sometimes people will use a stimulant
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  as a way to stay awake. And that, of course, comes with lots and lots of problems,
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  the synergistic effect of the two drugs and so forth. So-
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  We're talking about drug use for the effect of the drug and not for finding
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  ways to make you more productive in whatever it is that you're trying to do, necessarily.
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  Well, it's kind of interesting that you ask that because as I was preparing
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  for this, most of the research on this silent stimulant epidemic is focusing
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  on illegal stimulants, methamphetamine, cocaine.
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  But there is interesting research, just looking at the data,
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  that would show that there's been this explosive increase in prescriptions.
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  So legal prescriptions for stimulants in the last 10 or 15 years.
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  There has been an increase in diagnoses for things like ADHD,
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  for which stimulants are most commonly prescribed, but it's been a pretty minimal
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  increase and not nearly an increase that's commensurate with the giant increase
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  in stimulant prescriptions.
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  And so the reason I went there and answered your question is because I suspect,
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  I kind of know as a matter of fact,
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  that some people are using stimulant medications prescribed by physicians really
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  as performance enhancement, not like bodybuilding or baseball playing,
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  but to go to work, to go to be able to work longer hours or concentrate better and focus better.
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  And so there's been about a 250% increase in legal stimulant prescriptions in
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  the last 10 or 15 years, which is a pretty almost the same threefold increase
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  we've seen in illegal stimulant overdoses.
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  So there's an appetite in the United States for stimulants, it would seem. Yes. Yeah.
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  Well, and I think it's probably the same crowd that I knew when I was in college
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  who were taking stimulants to make sure that they got through class and...
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  Using alcohol or whatever other depressants to get through the night. So, you know.
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  Yeah. And it's a great point that you're making because it really reinforces
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  the notion that people who use drugs, you know, we, especially when we talk
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  about illegal drugs, we like to imagine just bad people, horrible people doing
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  bad things, but most people who use drugs are just people.
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  And so that includes lots of college students, lots and lots.
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  When I, you know, I teach a class at the university of Kentucky where we,
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  talk about addiction and drug use.
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  And my students talk endlessly about rampant Adderall use and off-label stimulant use,
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  not abusing it in the sense of trying to get a high out of it,
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  but trying to get into law school or get into med school or whatever it is. So yeah. Yeah. Okay.
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  Which is the more pressing problem, opioids or stimulants?
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  That's a good question. I'm going to cop out a little bit because you look at
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  the numbers, They're pretty similar.
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  So I'd say they're both really pressing concerns.
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  There are some reasons that we might be more concerned about.
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  Well, okay. First of all, there are geographic trends that make these things different.
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  So for instance, what in Kentucky, which is mostly a very rural state,
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  stimulant use disorder is the most common kind of addiction,
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  the most common kind of substance use disorder that's diagnosed in rural counties.
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  So even though we continue to hear about the opioid crisis and should,
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  stimulants in rural counties are the most common problem.
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  And the one reason why we might be more concerned about stimulants than anything
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  else is because we don't have evidence-based treatments.
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  So just to give context, if you have a problem with opioids,
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  if you have an opioid use disorder, we have medications that are really effective at treating that.
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  And we've talked about these in previous podcasts before, methadone,
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  buprenorphine, naltrexone, those medications don't exist for stimulants.
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  And it's not for lack of trying. In.
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  Dr. Craig Rush at University of Kentucky, one of our very own,
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  has been working diligently for many years at trying to develop this kind of
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  an intervention, a pharmacological intervention to treat stimulant use disorder.
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  And it doesn't exist, at least to date. So the closest thing we have is some
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  providers will, this is a pretty, I guess, progressive,
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  some providers will prescribe stimulants like Adderall and Vyvanse off-label
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  for people who have addictions to other stimulants.
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  And the idea being you're better off using the safe supply of Adderall that
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  I've given you that's FDA approved than you are using the methamphetamine or
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  cocaine that you're getting on the street.
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  So we don't really have good strategies. And for that reason,
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  there should be some real concern about how we're going to address the increase
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  in overdoses around stimulants.
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  Okay. Yeah. As we think about stimulants, and you said that smoking has become
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  a more common use or way of getting that stimulant,
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  are we seeing overdoses with stimulant smoking use?
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  Yes. So huge increase in stimulants and in smoking, and those coincide mostly
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  because people are smoking stimulants, but not entirely.
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  You can smoke opioids. You can smoke just about anything.
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  But I think it also, to your question about which should we be more concerned
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  about, I think it kind of reinforces the point that something that I say a lot
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  when I'm teaching about addiction, that addiction is not a drug problem.
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  Addiction is a brain problem. And so there are some differences in the way that
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  drugs affect us. There's no doubt.
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  And there's different risk profiles and different considerations.
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  But at a bird's eye view, when we're talking about addiction and all this harm
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  to your brain, a drug is a drug is a drug.
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  And so it's almost less important, the specific interventions for this drug
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  or for that drug, and much more important that we address the big things that
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  we know, the holes that we have,
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  mental health care and housing and social support and transportation.
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  And those things are kind of not drug specific.
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  So all those things that extension works really hard to develop and promote
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  in communities, right? You were preempting my next question.
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  Like, what role do we have in addressing these trends?
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  And so, yeah. And that's often a question that people are like,
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  well, what can we do as extension to have a role in this fight?
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  And we do have a role because we address these concerns every day.
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  We do. And it's a really good question to make it relevant for listeners because,
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  you know, when we talk about stimulant use or when we talk about xylazine and
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  opioids or whatever it is, it's not that we're trying to make people out to be experts.
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  I don't want agents going out in the community and trying to identify xylazine.
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  The point is really to have an awareness of the,
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  What we specifically do within Extension, I go back to the fact that we build
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  recovery capital, which is another way of just saying really health and wellness.
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  When we improve someone's nutrition, when we improve their physical health,
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  when we improve their relationships and their social connection,
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  when we improve their finances, down the line, everything that we do in Extension is promoting recovery.
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  And that's recovery from stimulant use, from opioid use, from whatever it So
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  I think Extension is pretty darn cool.
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  Well, and our tagline, building strong families, building Kentucky, it starts with us.
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  That's what we do every day to make sure that we are a solid foundation for
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  whatever people are recovering from,
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  whether it is substance use or dysfunctional relationships or overeating.
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  Whatever your addiction is, we are here to help you. We like to say everybody's
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  in recovery from something.
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  So whatever you're in recovery from, we do that in extension.
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  We do. And we try, you know, you do say that you can't be all things to all
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  people, but we sort of can.
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  We're going to give it a shot though, aren't we? That's right.
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  We're going to do our darn best to make sure that we can do something for everybody
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  because we do have so many fingers in the pot. And so we are going to do what we can.
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  Alex, thanks so much for taking the time to share with me today.
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  Yeah. As always, do you have any last thoughts? No, I don't.
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  I don't have anything else.
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  All righty. Well, thank you so much for your time. If you are just tuning in,
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  agent for Family and Consumer Sciences.
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  We build strong families. We build Kentucky. It starts with us.
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  Music.