In the early 2000s, Oklahoma's drug problem had a name everyone recognized. OxyContin. Prescription opioids were being handed out by the handful, flooding communities from Tulsa to Lawton before anyone with a badge called it a crisis. That was wave one.
Then came wave two. Heroin. When the pill mills got shut down and prescriptions got harder to fill, people didn't get sober. They switched. Heroin was cheaper, easier to find, and hit harder.
Wave three arrived quietly and killed loudly. Fentanyl. A synthetic opioid fifty times more potent than heroin, manufactured in clandestine labs and pressed into counterfeit pills that looked exactly like the real thing. Overdose deaths climbed year over year. Oklahoma was not spared.
We are no longer in wave three.
We are now in wave four. And wave four is different in ways that matter enormously for anyone trying to understand what getting clean in Oklahoma actually requires today.
The first three waves of the opioid crisis were, at their core, opioid stories. The drugs changed but the mechanism was the same: opioid receptors, respiratory depression, overdose.
The fourth wave is a polysubstance story. It is defined by the simultaneous use of fentanyl and stimulants, primarily methamphetamine, in combinations that create an overdose profile no one in addiction medicine fully anticipated.
A 2023 peer-reviewed study published in the journal Addiction analyzed overdose death data across the United States from 2010 to 2021. The findings were stark. The proportion of overdose deaths involving both fentanyl and stimulants increased from 0.6% of all overdose deaths in 2010 to 32.3% in 2021. The sharpest rise began around 2015. By 2021, in states across the West, South, and Midwest, including Oklahoma, methamphetamine-fentanyl co-involvement was the dominant pattern in fentanyl-related overdose deaths.
That is a complete reorientation of what the crisis looks like on the ground.
Oklahoma has always had a complicated relationship with methamphetamine. The state saw some of the earliest and most intense meth epidemics in the country, and meth never really left. What changed is what meth is now traveling alongside.
According to the Oklahoma State Department of Health's own overdose data, fentanyl overdose deaths in Oklahoma increased nearly six-fold from 2020 to 2023, rising from 127 deaths to 730 in that three-year span. In 2024, fentanyl was involved in 86% of all opioid-related overdose deaths in the state, compared to roughly 10 to 20% annually before 2020. Methamphetamine remained the most commonly identified drug in Oklahoma overdose deaths overall, recorded in 760 deaths in 2024 alone.
Meth and fentanyl act on completely different systems in the body. Fentanyl is a central nervous system depressant. It slows breathing, lowers heart rate, and in high doses, stops respiration entirely. Methamphetamine is a powerful stimulant. It floods the brain with dopamine, accelerates heart rate, and in chronic use, causes profound neurological changes that affect mood, cognition, sleep, and motivation for months after the last use.
When someone is dependent on both, detox is not a matter of managing one withdrawal syndrome. It is a matter of managing two, simultaneously, in a body that has adapted to chemicals pushing it in opposite directions at the same time.
A 2023 review published in Preventive Medicine was direct on this point: despite the substantial and growing role of stimulants in the current overdose crisis, evidence-based treatment specifically designed for stimulant use disorder remains severely underdeveloped. The clinical infrastructure that exists for opioid withdrawal, including medication-assisted treatment protocols, has no direct equivalent for methamphetamine. That gap is real, and it is part of why polysubstance detox requires a higher level of individualized medical oversight than single-substance withdrawal.
This is precisely why the clinical approach at Renewal Springs starts with a comprehensive health assessment before any treatment protocol is determined. There is no one-size-fits-all plan when two different systems are in withdrawal at the same time.
Opioid withdrawal gets most of the public attention because it is dramatic and physically visible. Meth withdrawal is quieter but in many ways harder to sustain through.
The crash in the first one to three days brings crushing fatigue and low mood. Days three through seven often bring intensified anxiety, sleep disruption, and irritability. Beyond the first week, cravings persist and mood stabilization can take weeks, sometimes months. The dopamine system, which methamphetamine hijacks so aggressively during use, does not bounce back quickly. The neurological recovery from long-term meth use is a slow process.
For someone also managing fentanyl detox alongside meth withdrawal, the early days are particularly unstable. Opioid withdrawal symptoms, including muscle aches, gastrointestinal distress, anxiety, and insomnia, compound the meth crash in ways that make early departure from treatment extremely tempting. Around-the-clock medical supervision is not optional in this context. It is the thing that keeps people safe and in treatment long enough for stabilization to begin.
The meth detox program at Renewal Springs provides 24/7 nursing oversight, medications to address anxiety and sleep disruption when clinically appropriate, and nutritional support to begin replenishing what extended stimulant use depletes. What it also provides, and this matters more than it sounds, is a team that knows what this specific withdrawal profile looks like and doesn't minimize it.
Medication-Assisted Treatment is one of the most evidence-supported tools in opioid detox. Buprenorphine and other medications work by binding to opioid receptors, reducing the acute intensity of withdrawal, and lowering the physiological drive toward relapse in the earliest days of recovery.
For someone detoxing from fentanyl, MAT is a clinically sound component of care. For the meth side of a polysubstance presentation, the pharmacological landscape is less developed. There is no equivalent of buprenorphine for methamphetamine. What does exist is medical management of the symptoms: medications to address the anxiety, insomnia, and cardiovascular stress that accompany stimulant withdrawal, administered carefully alongside opioid-specific protocols.
This is another reason why the dual-substance profile of Oklahoma's current crisis demands a more sophisticated clinical response than what standard treatment models were designed for. The people walking through detox doors in Oklahoma City in 2026 are often not presenting with the single-substance profiles that shaped most of the research and protocol development of the last two decades.
If you or someone you love is using meth and fentanyl, or has been, the most important thing to understand is that the detox process needs to account for both. A program that treats fentanyl dependence without addressing stimulant use, or vice versa, is addressing half the problem.
Renewal Springs provides medically supervised detox for polysubstance use, including the meth and fentanyl combinations that now define the overdose landscape in Oklahoma. The program includes wearable health monitoring technology through a partnership with Huml Health, which gives the clinical team real-time data on vital signs, sleep, and stress throughout the stay. That level of continuous monitoring is particularly meaningful in a polysubstance detox, where the interaction between two withdrawal syndromes can shift quickly.
The first step is the same regardless of where you are in that process: a conversation with someone who understands what you are dealing with. The admissions team at Renewal Springs includes staff in recovery themselves. They know what this looks like from the inside. You can also verify your insurance online in a few minutes to find out what your plan covers before anything else.
Call 405-725-2592 to speak directly with someone today. The call is confidential and there is no obligation. For a crisis this specific and this serious, the right kind of help exists, and it is in Oklahoma City.