Overdose deaths involving methamphetamine nearly tripled prior to COVID-19 pandemic

In the United States, overdose deaths that involved psychostimulants other than cocaine —mostly methamphetamine — rose 180% in the last 5 full years before the COVID-19 pandemic, a cross-sectional analysis of nationwide data showed.

“It is still unclear how trends in methamphetamine use among vulnerable populations and specific patterns of methamphetamine use (eg, with or without cocaine, frequent use, [methamphetamine use disorder] and injection) may be associated with greater risk for overdose mortality,” Beth Han, MD, PhD, MPH, an epidemiologist within the National Institute on Drug Abuse (NIDA) Science Policy Branch, and colleagues wrote.

“Understanding changes in the patterns of methamphetamine use as functions of age, sex and sexual orientation and race/ethnicity may help explain the increases in overdose deaths and inform prevention and treatment interventions,” they wrote.

Han and colleagues reviewed data on methamphetamine use, methamphetamine use disorder (MUD), injection and frequency of use from 195,711 individuals aged 18 to 64 years — “the population at the highest risk for substance use and overdose mortality,” according to the researchers — who participated in the 2015 to 2019 National Surveys on Drug Use and Health. The analysis also included mortality data for the corresponding years in the National Vital Statistics System Multiple Cause of Death. Most of the participants were women and white individuals.

Over the 5-year study period, the data showed that:

• overdose deaths that involved psychostimulants other than cocaine (mostly methamphetamine) rose 180%, from 5,526 deaths to 15,489 deaths (P for trend < .001);
• methamphetamine use rose 43%, from 1.4 million persons to 2 million persons (P for trend = .002);
• frequent methamphetamine use rose 66%, from 615,000 persons to 1,021,000 persons (P for trend = .002);
• methamphetamine and cocaine use rose 60%, from 402,000 persons to 645,000 persons (P for trend = .001); and
• MUD without injection rose 105% (from 397,000 persons to 815,000 persons; P for trend = .006).

Also, from 2015 to 2019, the adjusted prevalence of MUD that did not contain an injection more than tripled among heterosexual women (from 0.24% to 0.74%; P < .001) and lesbian or bisexual women (from 0.21% to 0.71%; P < .001), and it more than doubled in heterosexual men (from 0.29% to 0.79%; P < .001) and homosexual or bisexual men (from 0.29% to 0.8%; P = .007). The prevalence also increased more than 10-fold in Black persons (from 0.06% to 0.64%; P < .001), almost tripled in white persons (from 0.28% to 0.78%; P < .001) and more than doubled in Hispanic persons (from 0.39% to 0.82%; P < .001), according to the researchers.

In addition, the prevalence of MUD or injection exceeded the prevalence of methamphetamine use among those without the disorder or an injection annually from 2017 to 2019 (60% to 67% vs. 37% to 40%; P for trend .001). Persons with MUD or utilized injection were more likely to frequently use methamphetamine (52.68% to 53.84% vs. 32.59%; adjusted risk ratio = 1.62-1.65; 95% CI, 1.35-1.94), data showed.

“Given the indicators of the growth of methamphetamine use during the COVID-19 pandemic, the prevalence of MUD and injection may have further accelerated during 2020 to 2021,” Han and colleagues added.

Risk factors linked to methamphetamine use, MUD, injection and frequent use included a lower level of education, lower annual household income, absence of insurance, unstable housing, engagement with the criminal justice system, comorbidities (eg, hepatitis B virus, hepatitis C virus, HIV/AIDS, depression), suicidal ideation and polysubstance use, according to the researchers.

“What makes these data even more devastating is that currently, there are no approved medications to treat methamphetamine use disorder,” Emily Einstein, PhD, the chief of NIDA’s Science Policy Branch and a study co-author, said in a press release. The agency is “working to develop new treatment approaches, including safe and effective medications urgently needed to slow the increase in methamphetamine use, overdoses, and related deaths,” she said.

In the meantime, the researchers encouraged “implementation of evidence-based prevention and treatment interventions” to counter the rise of methamphetamine use and MUD.