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Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults

Educational Objective
To assess the national trends in and correlates of past-year methamphetamine use, methamphetamine use disorder (MUD), injection, frequent use, and associated overdose mortality from 2015 to 2019.
1 Credit CME
Key Points

Question  Are trends in methamphetamine use among populations with socioeconomic risk factors and comorbidities associated with increases in overdose mortality?

Findings  In this cross-sectional study of 195 711 respondents to a national survey from 2015 to 2019, methamphetamine use, frequent use, co-use with cocaine, and methamphetamine use disorder increased 43% to 105%. Methamphetamine use disorder without injection doubled overall and increased 10-fold among Black individuals, and risk factors included lower socioeconomic status factors, criminal justice involvement, and comorbidities.

Meaning  This study found riskier patterns of methamphetamine use and increased diversity in populations with methamphetamine use disorder risk (particularly those with socioeconomic risk factors and comorbidities) during a time of increasing overdose mortality.

Abstract

Importance  Mortality associated with methamphetamine use has increased markedly in the US. Understanding patterns of methamphetamine use may help inform related prevention and treatment.

Objective  To assess the national trends in and correlates of past-year methamphetamine use, methamphetamine use disorder (MUD), injection, frequent use, and associated overdose mortality from 2015 to 2019.

Design, Setting, and Participants  This cross-sectional study analyzed methamphetamine use, MUD, injection, and frequent use data from participants in the 2015 to 2019 National Surveys on Drug Use and Health (NSDUH). Mortality data were obtained from the 2015 to 2019 National Vital Statistics System Multiple Cause of Death files.

Exposures  Methamphetamine use.

Main Outcomes and Measures  Methamphetamine use, MUD, injection, frequent use, and overdose deaths.

Results  Of 195 711 NSDUH respondents aged 18 to 64 years, 104 408 were women (weighted percentage, 50.9%), 35 686 were Hispanic individuals (weighted percentage, 18.0%), 25 389 were non-Hispanic Black (hereafter, Black) individuals (weighted percentage, 12.6%), and 114 248 were non-Hispanic White (hereafter, White) individuals (weighted percentage, 60.6%). From 2015 to 2019, overdose deaths involving psychostimulants other than cocaine (largely methamphetamine) increased 180% (from 5526 to 15 489; P for trend <.001); methamphetamine use increased 43% (from 1.4 million [95% CI, 1.2-1.6 million] to 2.0 million [95% CI, 1.7-2.3 million]; P for trend = .002); frequent methamphetamine use increased 66% (from 615 000 [95% CI, 512 000-717 000] to 1 021 000 [95% CI, 860 000-1 183 000]; P for trend = .002); methamphetamine and cocaine use increased 60% (from 402 000 [95% CI, 306 000-499 000] to 645 000 [95% CI, 477 000-813 000]; P for trend = .001); and MUD without injection increased 105% (from 397 000 [95% CI, 299 000-496 000] to 815 000 [95% CI, 598 000-1 033 000]; P for trend = .006). The prevalence of MUD or injection surpassed the prevalence of methamphetamine use without MUD or injection in each year from 2017 to 2019 (60% to 67% vs 37% to 40%; P for trend ≤.001). Adults with MUD or using injection were more likely to use methamphetamine frequently (52.68%-53.84% vs 32.59%; adjusted risk ratio, 1.62-1.65; 95% CI, 1.35-1.94). From 2015 to 2019, the adjusted prevalence of MUD without 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 more than doubled among heterosexual men (from 0.29% to 0.79%; P < .001) and homosexual or bisexual men (from 0.29% to 0.80%; P = .007). It increased over 10-fold among Black individuals (from 0.06% to 0.64%; P < .001), nearly tripled among White individuals (from 0.28% to 0.78%; P < .001), and more than doubled among Hispanic individuals (from 0.39% to 0.82%; P < .001). Risk factors for methamphetamine use, MUD, injection, and frequent use included lower educational attainment, lower annual household income, lack of insurance, housing instability, criminal justice involvement, comorbidities (eg, HIV/AIDS, hepatitis B or C virus, depression), suicidal ideation, and polysubstance use.

Conclusions and Relevance  This cross-sectional study found consistent upward trends in overdose mortality, greater risk patterns of methamphetamine use, and populations at higher risk for MUD diversifying rapidly, particularly those with socioeconomic risk factors and comorbidities. Evidence-based prevention and treatment interventions are needed to address surges in methamphetamine use and MUD.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: July 21, 2021.

Published Online: September 22, 2021. doi:10.1001/jamapsychiatry.2021.2588

Corresponding Author: Beth Han, MD, PhD, MPH, National Institute on Drug Abuse, National Institutes of Health, 301 N Stonestreet Ave, 3WFN, Room 09C24, MSC 6024, Bethesda, MD 20892-6024 (Beth.Han@NIH.gov).

Author Contributions: Dr Han had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Han, Compton, Jones.

Drafting of the manuscript: Han, Volkow.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Han, Jones.

Administrative, technical, or material support: Einstein, Volkow.

Supervision: Volkow.

Conflict of Interest Disclosures: Dr Compton reported long-term stock holdings with General Electric Company, 3M Company, and Pfizer outside the submitted work. No other disclosures were reported.

Funding/Support: This study was sponsored by the National Institute on Drug Abuse of the National Institutes of Health and the Centers for Disease Control and Prevention.

Role of the Funder/Sponsor: The sponsors reviewed and approved the manuscript but had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed herein are those of the authors and do not reflect the official policy or position of the National Institute on Drug Abuse, the National Institutes of Health, the Centers for Disease Control and Prevention, and the US Department of Health and Human Services.

References
1.
Hedegaard  H , Miniño  AM , Warner  M . Drug Overdose Deaths in the United States, 1999–2019. National Center for Health Statistics, Centers for Disease Control and Prevention. NCHS Data Brief, no 394. Accessed March 8, 2021. https://www.cdc.gov/nchs/products/databriefs/db394.htm
2.
Han  B , Cotto  J , Etz  K , Einstein  EB , Compton  WM , Volkow  ND .  Methamphetamine overdose deaths in the US by sex and race and ethnicity.   JAMA Psychiatry. 2021;78(5):564-567. doi:10.1001/jamapsychiatry.2020.4321 PubMedGoogle ScholarCrossref
3.
National Center for Health Statistics, Centers for Disease Control and Prevention. Provisional drug overdose death counts. Accessed on April 15, 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
4.
Han  B . Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2020. HHS Publication No. PEP20-07-01-001, NSDUH Series H-55.
5.
Ellis  MS , Kasper  ZA , Cicero  TJ .  Twin epidemics: the surging rise of methamphetamine use in chronic opioid users.   Drug Alcohol Depend. 2018;193:14-20. doi:10.1016/j.drugalcdep.2018.08.029 PubMedGoogle ScholarCrossref
6.
Mei  DS , Cai  YJ , Wang  FM ,  et al.  Reciprocal substitution between methamphetamine and heroin in terms of reinforcement effects in rats.   Front Psychiatry. 2020;11:750. doi:10.3389/fpsyt.2020.00750 PubMedGoogle ScholarCrossref
7.
Palamar  JJ , Han  BH , Keyes  KM .  Trends in characteristics of individuals who use methamphetamine in the United States, 2015-2018.   Drug Alcohol Depend. 2020;213:108089. doi:10.1016/j.drugalcdep.2020.108089 PubMedGoogle Scholar
8.
Jones  CM , Underwood  N , Compton  WM .  Increases in methamphetamine use among heroin treatment admissions in the United States, 2008-17.   Addiction. 2020;115(2):347-353. doi:10.1111/add.14812 PubMedGoogle ScholarCrossref
9.
Jones  CM , Olsen  EO , O’Donnell  J , Mustaquim  D .  Resurgent methamphetamine use at treatment admission in the United States, 2008-2017.   Am J Public Health. 2020;110(4):509-516. doi:10.2105/AJPH.2019.305527 PubMedGoogle ScholarCrossref
10.
Kariisa  M , Scholl  L , Wilson  N , Seth  P , Hoots  B .  Drug overdose deaths involving cocaine and psychostimulants with abuse potential—United States, 2003-2017.   MMWR Morb Mortal Wkly Rep. 2019;68(17):388-395. doi:10.15585/mmwr.mm6817a3 PubMedGoogle ScholarCrossref
11.
Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH). Accessed February 21, 2021. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
12.
National Center for Health Statistics. National Vital Statistics System: mortality statistics. Accessed March 8, 2021. https://www.cdc.gov/nchs/nvss/deaths.htm
13.
Han  B , Compton  WM , Blanco  C , Crane  E , Lee  J , Jones  CM .  Prescription opioid use, misuse, and use disorders in U.S. adults: 2015 National Survey on Drug Use and Health.   Ann Intern Med. 2017;167(5):293-301. doi:10.7326/M17-0865 PubMedGoogle ScholarCrossref
14.
Mojtabai  R , Olfson  M , Han  B .  National trends in the prevalence and treatment of depression in adolescents and young adults.   Pediatrics. 2016;138(6):e20161878. doi:10.1542/peds.2016-1878 PubMedGoogle Scholar
15.
Shiffman  S , Waters  A , Hickcox  M .  The Nicotine Dependence Syndrome Scale: a multidimensional measure of nicotine dependence.   Nicotine Tob Res. 2004;6(2):327-348. doi:10.1080/1462220042000202481 PubMedGoogle ScholarCrossref
16.
Grucza  RA , Abbacchi  AM , Przybeck  TR , Gfroerer  JC .  Discrepancies in estimates of prevalence and correlates of substance use and disorders between two national surveys.   Addiction. 2007;102(4):623-629. doi:10.1111/j.1360-0443.2007.01745.x PubMedGoogle ScholarCrossref
17.
Jordan  BK , Karg  RS , Batts  KR , Epstein  JF , Wiesen  C .  A clinical validation of the National Survey on Drug Use and Health assessment of substance use disorders.   Addict Behav. 2008;33(6):782-798. doi:10.1016/j.addbeh.2007.12.007 PubMedGoogle ScholarCrossref
18.
Substance Abuse and Mental Health Services Administration.  Reliability of Key Measures in the National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration; 2010. Office of Applied Studies Methodology Series M-8. HHS Publication No. SMA 09-4425.
19.
Han  B , Compton  WM , Gfroerer  J , McKeon  R .  Prevalence and correlates of past 12-month suicide attempt among adults with past-year suicidal ideation in the United States.   J Clin Psychiatry. 2015;76(3):295-302. doi:10.4088/JCP.14m09287 PubMedGoogle ScholarCrossref
20.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. American Psychiatric Association; 2000.
21.
Fletcher  JB , Swendeman  D , Reback  CJ .  Mental health and substance use disorder comorbidity among methamphetamine-using men who have sex with men.   J Psychoactive Drugs. 2018;50(3):206-213. doi:10.1080/02791072.2018.1447173 PubMedGoogle ScholarCrossref
22.
Kuo  CJ , Liao  YT , Chen  WJ , Tsai  SY , Lin  SK , Chen  CC .  Causes of death of patients with methamphetamine dependence: a record-linkage study.   Drug Alcohol Rev. 2011;30(6):621-628. doi:10.1111/j.1465-3362.2010.00255.x PubMedGoogle ScholarCrossref
23.
Shearer  RD , Howell  BA , Bart  G , Winkelman  TNA .  Substance use patterns and health profiles among US adults who use opioids, methamphetamine, or both, 2015-2018.   Drug Alcohol Depend. 2020;214:108162. doi:10.1016/j.drugalcdep.2020.108162 PubMedGoogle Scholar
24.
Howell  BA , Bart  G , Wang  EA , Winkelman  TNA .  Service involvement across multiple sectors among people who use opioids, methamphetamine, or both, United States-2015-2018.   Med Care. 2021;59(3):238-244. doi:10.1097/MLR.0000000000001460 PubMedGoogle ScholarCrossref
25.
Bieler  GS , Brown  GG , Williams  RL , Brogan  DJ .  Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data.   Am J Epidemiol. 2010;171(5):618-623. doi:10.1093/aje/kwp440 PubMedGoogle ScholarCrossref
26.
Bonk  R , Miller  RJ , Lanter  J , Niblo  C , Kemp  J , Shelton  J .  Accidental overdose deaths in Oklahoma, 2002-2017: opioid and methamphetamine trends.   J Anal Toxicol. 2020;44(7):672-678. doi:10.1093/jat/bkaa068 PubMedGoogle ScholarCrossref
27.
Daniulaityte  R , Silverstein  SM , Crawford  TN ,  et al.  Methamphetamine use and its correlates among individuals with opioid use disorder in a Midwestern U.S. city.   Subst Use Misuse. 2020;55(11):1781-1789. doi:10.1080/10826084.2020.1765805 PubMedGoogle ScholarCrossref
28.
Strickland  JC , Havens  JR , Stoops  WW .  A nationally representative analysis of “twin epidemics”: rising rates of methamphetamine use among persons who use opioids.   Drug Alcohol Depend. 2019;204:107592. doi:10.1016/j.drugalcdep.2019.107592 PubMedGoogle Scholar
29.
McMahan  VM , Kingston  S , Newman  A , Stekler  JD , Glick  SN , Banta-Green  CJ .  Interest in reducing methamphetamine and opioid use among syringe services program participants in Washington State.   Drug Alcohol Depend. 2020;216:108243. doi:10.1016/j.drugalcdep.2020.108243 PubMedGoogle Scholar
30.
Al-Tayyib  A , Koester  S , Langegger  S , Raville  L .  Heroin and methamphetamine injection: an emerging drug use pattern.   Subst Use Misuse. 2017;52(8):1051-1058. doi:10.1080/10826084.2016.1271432 PubMedGoogle ScholarCrossref
31.
Glick  SN , Klein  KS , Tinsley  J , Golden  MR .  Increasing heroin-methamphetamine (goofball) use and related morbidity among Seattle area people who inject drugs.   Am J Addict. 2021;30(2):183-191. doi:10.1111/ajad.13115PubMedGoogle Scholar
32.
Glick  SN , Burt  R , Kummer  K , Tinsley  J , Banta-Green  CJ , Golden  MR .  Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington.   Drug Alcohol Depend. 2018;182:86-92. doi:10.1016/j.drugalcdep.2017.10.011 PubMedGoogle ScholarCrossref
33.
Tupper  KW , McCrae  K , Garber  I , Lysyshyn  M , Wood  E .  Initial results of a drug checking pilot program to detect fentanyl adulteration in a Canadian setting.   Drug Alcohol Depend. 2018;190:242-245. doi:10.1016/j.drugalcdep.2018.06.020 PubMedGoogle ScholarCrossref
34.
Park  JN , Rashidi  E , Foti  K , Zoorob  M , Sherman  S , Alexander  GC .  Fentanyl and fentanyl analogs in the illicit stimulant supply: results from U.S. drug seizure data, 2011-2016.   Drug Alcohol Depend. 2021;218:108416. doi:10.1016/j.drugalcdep.2020.108416 PubMedGoogle Scholar
35.
Hussen  SA , Camp  DM , Jones  MD ,  et al.  Exploring influences on methamphetamine use among Black gay, bisexual and other men who have sex with men in Atlanta: a focus group study.   Int J Drug Policy. 2021;90:103094. doi:10.1016/j.drugpo.2020.103094 PubMedGoogle Scholar
36.
Rivera  AV , Harriman  G , Carrillo  SA , Braunstein  SL .  Trends in methamphetamine use among men who have sex with men in New York City, 2004-2017.   AIDS Behav. 2021;25(4):1210-1218. doi:10.1007/s10461-020-03097-5 PubMedGoogle ScholarCrossref
37.
Fletcher  JB , Swendeman  D , Reback  CJ .  Associations between major depressive episode, methamphetamine use disorder severity, and engagement in sexual risk-taking among methamphetamine-using men who have sex with men.   AIDS Behav. 2018;22(5):1461-1466. doi:10.1007/s10461-017-1974-4 PubMedGoogle ScholarCrossref
38.
Grov  C , Westmoreland  D , Morrison  C , Carrico  AW , Nash  D .  The crisis we are not talking about: one-in-three annual HIV seroconversions among sexual and gender minorities were persistent methamphetamine users.   J Acquir Immune Defic Syndr. 2020;85(3):272-279. doi:10.1097/QAI.0000000000002461 PubMedGoogle ScholarCrossref
39.
Beaulieu  T , Wood  E , Tobias  S ,  et al.  Is expected substance type associated with timing of drug checking service utilization?: a cross-sectional study.   Harm Reduct J. 2021;18(1):66. doi:10.1186/s12954-021-00514-3 PubMedGoogle ScholarCrossref
40.
Jones  CM , Einstein  EB , Compton  WM .  Changes in synthetic opioid involvement in drug overdose deaths in the United States, 2010-2016.   JAMA. 2018;319(17):1819-1821. doi:10.1001/jama.2018.2844 PubMedGoogle ScholarCrossref
41.
Wainwright  JJ , Mikre  M , Whitley  P ,  et al.  Analysis of drug test results before and after the US declaration of a national emergency concerning the COVID-19 outbreak.   JAMA. 2020;324(16):1674-1677. doi:10.1001/jama.2020.17694 PubMedGoogle ScholarCrossref
42.
Passaro  RC , Ramsey  K , Segura  ER ,  et al.  Speed kills: associations between methamphetamine use, HIV infection, tobacco use, and accelerated mortality among gay and bisexual men in Los Angeles, CA 20years after methamphetamine dependence treatment.   Drug Alcohol Depend. 2019;195:164-169. doi:10.1016/j.drugalcdep.2018.06.036 PubMedGoogle ScholarCrossref
43.
Compton  WM , Dawson  D , Duffy  SQ , Grant  BF .  The effect of inmate populations on estimates of DSM-IV alcohol and drug use disorders in the United States.   Am J Psychiatry. 2010;167(4):473-474. doi:10.1176/appi.ajp.2009.09081087 PubMedGoogle ScholarCrossref
44.
Ferguson  KM , Bender  K , Thompson  SJ .  Gender, coping strategies, homelessness stressors, and income generation among homeless young adults in three cities.   Soc Sci Med. 2015;135:47-55. doi:10.1016/j.socscimed.2015.04.028 PubMedGoogle ScholarCrossref
45.
Reuter  P , Caulkins  JP , Midgette  G .  Heroin use cannot be measured adequately with a general population survey.   Addiction. Published online March 2, 2021. doi:10.1111/add.15458 PubMedGoogle Scholar
46.
Drug Enforcement Administration, US Department of Justice. 2018 National Drug Threat Assessment. DEA-DCT-DIR-032-18. Accessed April 15, 2021. https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf
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