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Are trends in methamphetamine use among populations with socioeconomic risk factors and comorbidities associated with increases in overdose mortality?
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.
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.
Mortality associated with methamphetamine use has increased markedly in the US. Understanding patterns of methamphetamine use may help inform related prevention and treatment.
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.
Main Outcomes and Measures
Methamphetamine use, MUD, injection, frequent use, and overdose deaths.
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.
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.
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.
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