Examining the Fourth Wave of the Opioid Epidemic: What Nurses Need to Know?

The United States continues to experience an opioid epidemic, which has been described by three waves: prescription opioid use, heroin use, and use of synthetic fentanyl analogs. Currently, a new "fourth wave" has emerged, which includes the use of stimulants (methamphetamine and cocaine) and synthetic opioids. Combining stimulants with high-potency synthetic opioids, such as fentanyl and fentanyl analogs, is associated with an increased mortality. Recent changes in methamphetamine production have led to a surge in supply, purity, and potency, thereby exacerbating the crisis. Nurses must understand the physical and mental health impacts of these substances and recognize overdose signs, ensuring patient and staff safety during care. Evidence-based guidelines and Food and Drug Administration-approved treatments for stimulant use disorder are essential, with current emphasis on behavioral therapies. Nurses play a crucial role in implementing these strategies and must stay abreast of evolving best practices in managing this complex epidemic.