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TMS for Addiction: What’s the 4th Wave of the Opioid Epidemic? What’s the 4th Wave of the Opioid Epidemic? And How TMS Can Help with Addiction

You’ve probably heard of the opioid epidemic, but do you know what scientists mean by “the fourth wave”? Synthetic opioids like fentanyl now make up a majority of deaths related to overdose. In many cases, opioid use coincides with stimulant use and mental illness. Let’s talk about what all this means, what to do if you suspect someone is using opioids, and TMS for addiction.  


Three million people are currently diagnosed with opioid use disorder in the United States. Opioid addiction affects people from all educational and socioeconomic backgrounds. It often starts with prescription medications. More than 80% of heroin users say they began using opioids with pills. This led them to opioid use disorder.


Opioid use disorder is the clinical diagnosis for someone who’s dependent on opioids. Here’s what the symptoms of opioid use disorder (OUD) look like:1 


  • An intense desire or “need” to use opioids
  • Using opioids so much that it interferes with work, relationships, or obligations
  • Spending excessive time trying to get a substance or medication
  • Rising tolerance or feeling like you need higher doses over time
  • Wanting to “cut down” on opioids but feeling like you can’t
  • Continuous use, despite others asking you to stop
  • Using opioids in dangerous situations 
  • Stopping or putting off other activities to use opioids instead
  • Withdrawal when opioids are stopped


OUD is a physically and emotionally exhausting disorder. Even once people get help, the rate of relapse is high. If you or your family member had gotten treatment before and relapsed, know this isn’t your fault. Some research suggests that up to 91% of people who get treatment for OUD relapse, which is higher than alcohol and other substances.


Opioid use disorder is tragic to watch your loved one go through or endure yourself. The team at KarmaTMS wants you to know that if you’re struggling with opioid addiction, we’re here for you. We’re an integrative psychiatric treatment center focused on helping people with treatment-resistant mental illnesses get the help they deserve. 


But the modern opioid epidemic looks different today than in the 90s when it began. Scholars now call this “the fourth wave” of the opioid epidemic. But what does that mean? First, let’s go over a brief outline of the opioid epidemic in the United States. 

How Did We Get Here? 

The modern opioid epidemic partially started with doctors overprescribing prescription opioids. In the 1990s, physicians began treating pain more commonly with opioids. Pharmaceutical companies aggressively marketed drugs like Oxycontin and Opana. Between 2002 and 2011, about 25 million people in the United States were started on nonmedical pain relievers.1 


More than 11 million people misused or abused those prescriptions, and it’s no wonder why. Opioids are more addictive than other substances like cocaine and alcohol. You can become tolerant within just a few days of starting pain medications. Withdrawal from those medications is unpleasant even if you haven’t been using them for long.1 


These prescriptions led to an uptick in health complications from opioid use. Between 1999 and 2013, emergency department visits related to opioids tripled. In 2017, the United States declared a national emergency due to opioid overdoses. These overdoses have come in distinct waves, which led to more than 564,000 deaths between 1999 and 2020.


The CDC describes opioid-related overdoses in these three waves:

  • 1990: a rise in deaths related to prescription opioid overdoses
  • 2010: deaths rose related to heroin overdose
  • 2013: overdoses increased related to synthetic opioids, including fentanyl


These three distinct waves mark unique turning points in the opioid epidemic in the United States. It’s important to note that while prescription medications were primarily responsible for the first wave, the second and third have been related to illicit use. But you’ve probably heard about the fourth wave in the news or from friends and family. What does the fourth wave mean? And more specifically, what does it mean for you?

What Does “The Fourth Wave” Mean?

The fourth wave of the opioid epidemic started during the COVID-19 pandemic. Scholars believe complicated factors like regulations and more substance availability have caused this wave. The latest spike in deaths has increasingly been related to several factors, including:


  • Synthetic opioids like Fentanyl 
  • Psychostimulants, which include methamphetamines
  • Cocaine
  • Heroin 
  • Co-existing mental illnesses, like depression and anxiety


While each prior wave has been specifically linked to one substance, the fourth wave is more complex. Isolation during the pandemic worsened many mental health problems. People are more commonly caught in the crosshairs of more than one addiction. But what does the fourth wave mean for you? 

Key Takeaways on The Fourth Wave of the Opioid Epidemic

  • If you’re struggling with substance use, get help earlier rather than later. 


Illicit opioids are increasingly being “laced” with more dangerous substances, like fentanyl. This makes your risk of overdose with each use even higher. Single-use naloxone may not be enough to combat overdoses related to fentanyl. You’re also more at risk for HIV and hepatitis infections due to dirty needles. It’s never been more dangerous to be dependent on an illicit substance. 


If you’re struggling with opioid dependency and addiction, call the Substance Abuse and Mental Health Services (SAMHSA) number at 1-800-662-4357.

  • If you believe a friend or family member is dealing with OUD, there are actions you can take to try to help. 


Opioid use disorder coincides with changes in behavior and mood. To learn more about what you can do to help a loved one, see SAMHSA’s family resources page. 

  • Pain relievers are still necessary. 


Over-prescribing opioids is no longer a practice in most medical offices. In fact, regulatory changes have severely limited these prescriptions in the last several years. Some clinicians now believe that stigma around opioid prescriptions may be stopping their legitimate use.3 Opioid medications should be accessible for people who need them. You should get help if you’re in pain. 


The three key takeaways about the fourth wave of the opioid crisis are: 


  • Getting help now
  • Checking in with your loved ones
  • Understanding prescription pain medications


But can TMS help with OUD? Let’s talk about whether TMS for addiction and opioid use disorder is currently approved. 

Is TMS Therapy FDA Approved for Opioid Use Disorder?

TMS therapy is not approved for OUD right now, but that may change soon. It’s approved for helping people recover from nicotine addiction. And it’s shown to be helpful for substance dependency in trials on nicotine, cocaine, and alcohol., 


Like depression and anxiety, OUD can be described as a chronic and relapsing brain disease. It’s characterized by problems in brain circuits neurologically changing by repeated opioid exposure. Because of how OUD changes the brain, it becomes even harder for people to stop using opioids. But TMS for addiction may be able to help. 


TMS therapy could help with symptoms of drug cravings and help bring down drug use in people with OUD.5 In treatment-resistant depression, TMS therapy is thought to help by stimulating the brain to create new neural pathways. These pathways make way for new, healthier thought patterns. TMS may help with OUD through this same mechanism — helping people create new thought patterns rather than going down the pattern of cravings. 

TMS for Opioid Use Disorder: Next Steps

The team at KarmaTMS helps people with mental illnesses experience a better life with TMS therapy. If you or your family is struggling with opioid dependency or another addiction, the root of the problem may be mental illness. Integrative psychiatry and TMS therapy can help. Depression, trauma-related illnesses, and anxiety can all be linked with substance dependency. 


If you’re looking for support or help with mental illness, call our office. We can offer helpful direction for your next treatment steps. Our team of compassionate clinicians views substance dependency from a non-judgemental perspective, and we believe in every person’s ability to heal themselves. OUD isn’t a life sentence. A better life is possible. 


To speak with one of our representatives, call our office at 951-395-2321. 


 Azadfard M, Huecker MR, Leaming JM. Opioid Addiction. [Updated 2022 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448203/

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Manchikanti L, Singh VM, Staats PS, Trescot AM, Prunskis J, Knezevic NN, Soin A, Kaye AD, Atluri S, Boswell MV, Abd-Elsayed A, Hirsch JA. Fourth Wave of Opioid (Illicit Drug) Overdose Deaths and Diminishing Access to Prescription Opioids and Interventional Techniques: Cause and Effect. Pain Physician. 2022 Mar;25(2):97-124. PMID: 35322965.

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 Torres-Castaño A, Rivero-Santana A, Perestelo-Pérez L, Duarte-Díaz A, Toledo-Chávarri A, Ramos-García V, Álvarez-Pérez Y, Cudeiro-Mazaira J, Padrón-González I, Serrano-Pérez P. Transcranial Magnetic Stimulation for the Treatment of Cocaine Addiction: A Systematic Review. J Clin Med. 2021 Nov 28;10(23):5595. doi: 10.3390/jcm10235595. PMID: 34884297; PMCID: PMC8658408.

Steele, V. R. (2020). Transcranial magnetic stimulation as an interventional tool for addiction. Frontiers in Neuroscience, 14. https://doi.org/10.3389/fnins.2020.592343

Steele VR, Maxwell AM. Treating cocaine and opioid use disorder with transcranial magnetic stimulation: A path forward. Pharmacol Biochem Behav. 2021 Oct;209:173240. doi: 10.1016/j.pbb.2021.173240. Epub 2021 Jul 21. PMID: 34298030; PMCID: PMC8445657.


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