Trends in U.S. methamphetamine use and associated deaths

Understanding trends in methamphetamine use is crucial to developing effecting approaches to prevent and treat it. hikrcn / Shutterstock

Overdose deaths in the U.S. involving stimulants other than cocaine have risen sharply in recent years. Methamphetamine is the primary culprit in these deaths. Yet the increases in methamphetamine use and methamphetamine use disorder (MUD) have been much less dramatic. This suggests that the overdose risk among people who use methamphetamine has increased. It’s not clear what changes in methamphetamine use patterns could account for this.

To find out, a team of researchers led by Dr. Beth Han from NIH’s National Institute on Drug Abuse (NIDA) examined data from almost 200,000 people nationwide, aged 18-64, who participated in the 2015-2019 National Surveys on Drug Use and Health (NSDUH). They also examined data on overdose deaths during the same period from the National Vital Statistics System. Both NIDA and the CDC supported the study. Results appeared in JAMA Psychiatry on September 22, 2021.

The researchers found that overdose deaths from stimulants other than cocaine almost tripled from 2015 to 2019. Yet methamphetamine use increased by only 43% during the same period. The number of people using methamphetamine and cocaine together increased by 60%, and the number with MUD increased by 62%. Frequent methamphetamine use, defined as using for at least 100 days in the past year, increased by 66%. These results point to a growing trend in risky use patterns, which may have led to more overdose deaths.

The data further suggested that people who use methamphetamine have become more diverse. Historically, methamphetamine use has been prevalent among middle-aged white people. But the researchers found a tenfold increase in MUD without injection among Black people. This was much larger than among other racial and ethnic groups. MUD without injection also quadrupled among people aged 18-23 years, much larger than the growth among older age groups. 

The team also identified socioeconomic factors associated with methamphetamine use and MUD. These included low educational attainment, low household income, lack of insurance, housing instability, and involvement with the criminal justice system. People with hepatitis, HIV/AIDS, sexually transmitted diseases, or depression also had increased risk. Other risk factors included suicidal thoughts and use of other substances, such as nicotine, cannabis, and cocaine. However, due to the nature of the data, the causes of the increased methamphetamine use and MUD couldn’t be determined.

The researchers note that the survey data has other limitations. These include problems with self-reporting and the omission of people who are homeless and not living in shelters or are institutionalized. Thus, the analysis may have underestimated the prevalence of methamphetamine use and MUD. Death certificates do not always report the specific drugs involved, so death rates could also be underestimated.

“What makes these data even more devastating is that currently, there are no approved medications to treat methamphetamine use disorder,” says Dr. Emily Einstein, chief of NIDA’s Science Policy Branch and a co-author of the study. “NIDA 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.”