Methamphetamine Use and Overdoses Spike, especially Among Minorities Interview with:

Beth Han, M.D., Ph.D., M.P.H.
Epidemiologist, Science Policy Branch of the National Institute on Drug Abuse (NIDA),
National Institutes of Health What is the background for this study?

Response: In the U.S., overdose deaths involving psychostimulants with abuse potential other than cocaine (i.e. largely methamphetamine), increased dramatically during the past decade. Psychostimulant-involved overdose deaths also often involved opioids (50% in 2017). However, it was still undetermined how trends in methamphetamine use among vulnerable populations and specific patterns of use [e.g. methamphetamine use with or without other substances, frequent methamphetamine use, methamphetamine use disorder (MUD), and injection] may contribute to greater risk for overdose mortality. Moreover, understanding characteristics that are associated with methamphetamine use, frequent use, MUD, and injection is of value in guiding strategies to address the root causes for the recent surge in methamphetamine overdose deaths. What are the main findings?

Response: Based on the 2015-2019 National Vital Statistics System’s Multiple Cause of Death Files and the 2015-2019 National Surveys on Drug Use and Health (NSDUH) data, among persons aged 18-64 during 2015-2019, overdose deaths involving methamphetamine increased 180% from 5,526 to 15,489; methamphetamine use increased 43% from 1.4 million to 2.0 million; frequent methamphetamine use increased 66% from 615,000 to 1,021,000, methamphetamine and cocaine use increased 60% from 402,000 to 645,000; Methamphetamine Use Disorder without injection increased 105% from 397,000 to 815,000. Prevalence of MUD or injection (MUD/injection) surpassed prevalence of methamphetamine use without MUD/injection in each year during 2017-2019. Adults with MUD/injection were 1.6-1.7 times more likely to use methamphetamine frequently.

During 2015-2019, adjusted prevalence of Methamphetamine Use Disorder without injection more than tripled among heterosexual women and lesbian/bisexual women and more than doubled among heterosexual men and gay/bisexual men. It increased over 10-fold among non-Hispanic Blacks, nearly tripled among non-Hispanic whites, and more than doubled among Hispanics. Characteristics associated with methamphetamine use, frequent use, MUD, and injection included lower education, lower income, being uninsured, housing instability, criminal justice involvements, and having co-morbidities (e.g., HIV/AIDS, HBV/HCV, depression), suicidal ideation, and polysubstance use. What should readers take away from your report?

Response: There are four main takeaways that we would like to highlight from this study:

(1). During 2015-2019, among adults aged 18-64, increases in methamphetamine-involved overdose mortality exceeded increases in methamphetamine use.   This study’s findings of increases in higher risk patterns of methamphetamine use (frequent use, MUD, and polysubstance use) may help explain the marked increases in related overdose deaths during the study period.

(2). Populations at increased risk for MUD diversified rapidly during 2015-2019, particularly among those with socioeconomic risk factors and co-morbidities. Our results are consistent with increases in methamphetamine-related treatment admissions among non-Hispanic white, Black, American Indian or Alaska Native (AIAN) and Hispanic patients during 2007-2018, with the fastest increase among Black patients.

(3). Our results highlighted key risk factors, including lower education, lower household income, being uninsured, housing instability, criminal justice involvements, and having co-morbidities (e.g., HIV/AIDS, hepatitis B or C, sexually transmitted infection, major depressive episode), suicidal ideation, and polysubstance use. Co-use of opioids (knowingly or unknowingly) is a particularly important factor, given the increasing overlap of synthetic opioids (i.e., fentanyl-related agents) with methamphetamine-involved overdose deaths.

(4). Effective prevention and treatment interventions are needed to address methamphetamine use and Methamphetamine Use Disorder. Additionally, since fentanyl contaminated methamphetamine is also contributing to increase in methamphetamine overdose, prevention interventions that include access to drug checking services, such as fentanyl test strips, may be useful. What recommendations do you have for future research as a result of this work?

Response: A major challenge in addressing the high rates of methamphetamine-related morbidity and mortality is the lack of FDA-approved medications for Methamphetamine Use Disorder treatment, highlighting the urgency for further research and investments in MUD medication development.

In addition, research on implementation of evidence-based prevention interventions and on public policies is needed to effectively respond to the surge in methamphetamine use and related harms. For example, expansion of community-based interventions to reduce injection drug use-related harms and overdoses such as comprehensive syringe services programs could help mitigate overdose risks and the additional spread of infectious diseases such as hepatitis B or C and HIV. Is there anything else you would like to add?

Response: Given indicators of increasing methamphetamine use during the COVID-19 pandemic, prevalence of Methamphetamine Use Disorder and injection may have further accelerated during 2020-2021.

It is also important to note that estimates of overdose deaths do not include most people who die from methamphetamine-related health problems (e.g., strokes, myocardial infarction, pulmonary hypertension, HIV/AIDS, hepatitis B or C). Methamphetamine-related mortality and harms are likely to be markedly underestimated when only considering overdose deaths.

And finally, this study has several limitations.

  • The cross-sectional nature of NSDUH data precludes drawing causal relationships.
  • This study may underestimate prevalence of methamphetamine use, use frequency, MUD, and injection because the NSDUH sample does not include people experiencing homelessness not living in shelters and institutionalized populations (e.g., jail/prison populations) who often have more drug use than the general population and may be at increased risk of methamphetamine overdose deaths.
  • NSDUH is a self-report survey and is subject to recall and social-desirability bias.
  • Approximately 85-90% of death certificates involving psychostimulants other than cocaine mentioned methamphetamine. We may have underestimated mortality because some overdose death certificates did not report the specific drugs involved (e.g., 6% in 2019).

Despite these limitations, this study found that consistent with increases in overdose mortality, higher risk patterns of methamphetamine use increased; and populations at increased MUD risk diversified rapidly, particularly among those with socioeconomic risk factors and co-morbidities.

Combating the surges in methamphetamine use, Methamphetamine Use Disorder, and associated mortality warrants the implementation of evidence-based prevention and treatment interventions.

Dr. Han has nothing to disclose.


Han B, Compton WM, Jones CM, Einstein EB, Volkow ND. Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry. Published online September 22, 2021. doi:10.1001/jamapsychiatry.2021.2588

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Sep 24, 2021 @ 7:19 pm 

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