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National Spike in Methamphetamine Overdose Deaths

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The national rate of methamphetamine overdose deaths shot up significantly between 2011 and 2018, particularly among non-Hispanic American Indian and Alaska Native communities, new research shows.

Rates rose for both men and women but more so among men, the study found. The spike in these deaths underscores the need for culturally tailored prevention and treatment strategies, the study authors said.

“While much attention is focused on the opioid crisis, a methamphetamine crisis has been quietly, but actively, gaining steam — particularly among American Indians and Alaska Natives, who are disproportionately affected by a number of health conditions,” senior investigator Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA), National Institutes of Health, said in a press release.

The study was published online January 20 in JAMA Psychiatry.

Highly Toxic

Methamphetamine is highly toxic. Its use is associated with pulmonary and cardiovascular pathology and frequently co-occurs with other substance use and mental disorders.

In addition, there are currently no US Food and Drug Administration-approved medications to reverse methamphetamine overdose or treat methamphetamine use disorder.

However, behavioral therapies can be effective in reducing the harm associated with methamphetamine use. In addition, a recent clinical trial reported significant therapeutic benefits with the combination of naltrexone with bupropion in patients with methamphetamine use disorder.

For the study, the investigators used deidentified public health surveillance data from the Centers for Disease Control and Prevention’s National Vital Statistics System files for multiple causes of death.

The researchers used the psychostimulant category to estimate death rates from methamphetamine. The authors note that up to 90% of psychostimulant-involved death certificates mentioned methamphetamine.

Researchers stratified age-adjusted overdose death rates during 2011-2018 by sex and race/ethnicity and limited the analysis to those aged 25 to 54 years. Approximately 80% of methamphetamine users are between the ages of 25 to 54 years.

During the study period, rates for methamphetamine-involved deaths increased from 1.8 to 10.1 per 100,000 among men (average annual percentage change [AAPC], 29.1; 95% confidence interval [CI], 25.5 – 32.8; P < .001) and from 0.8 to 4.5 per 100,000 among women (AAPC, 28.1; 95% CI, 25.1 – 31.2; P < .001).

Need for Tailored Interventions

For both men and women, those in non-Hispanic American Indian or Alaska Native communities had the highest rates. These increased from 5.6 to 26.4 per 100,000 among men and from 3.6 to 15.6 per 100,000 among women.

While American Indian and Alaska Native individuals experience sociostructural disadvantages, their cultural strengths “can be leveraged to improve addiction outcomes,” the investigators write.

Non-Hispanic Whites had the second highest rates. These rose from 2.2 to 12.6 per 100,000 among men (AAPC, 29.8; 95% CI, 24.3 – 35.4; P < .001) and from 1.1 to 6.2 per 100,000 among women (AAPC, 29.1; 95% CI, 25.2 – 33.2; P < .001).

Rates among Hispanic individuals increased from 1.4 to 6.6 per 100,000 for men and from 0.5 to 2.0 per 100,000 for women. Among non-Hispanic Asian individuals, rates increased to 3.4 per 100,000 for men and to 1.1 per 100,000 for women. Non-Hispanic Black individuals had low rates. Within each racial/ethnic group, rates were higher among men vs women.

Methamphetamine death rates may be underestimated because some overdose death certificates do not report specific drugs involved, the authors note.

Identifying populations that have a higher rate of methamphetamine overdose is a crucial step toward curbing the underlying methamphetamine crisis,” said study author Beth Han, MD, PhD, of NIDA, in a press release.

“By focusing on the unique needs of individuals and developing culturally tailored interventions, we can begin to move away from one-size-fits-all approaches and toward more effective, tailored interventions,” she said.

This study was sponsored by the National Institute on Drug Abuse of the National Institutes of Health.

JAMA Psychiatry. Published online January 20, 2021.

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