Methamphetamine use in the United States: epidemiological update and implications for prevention, treatment, and harm reduction

Abstract

Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices.

Keywords: methamphetamine; opioid; overdose.

Figure 1.

Psychostimulant-involved overdose deaths with and without opioid involvement, and the percentage of psychostimulant-involved overdose deaths involving synthetic opioids in the United States, 2010–2019. Data source: 2010–2019 National Vital Statistics System. Underlying cause of death (X40–44, X60–64, X85, Y10–14). Psychostimulant-involved overdose deaths (T43.7); any opioid (T40.0-T40.4, T40.6); synthetic opioids (T40.4).

Figure 2.

Methamphetamine injection, use disorder, receipt of substance use treatment and frequency of use, other substance use, and mental illness among adults ≥ 18 years old reporting past-year methamphetamine use in the United States, 2015–2018. Source: National Surveys on Drug Use and Health, 2015–2018; NSDUH uses 2010 Census–based population estimates. Receipt in past year among those with a methamphetamine use disorder; all other percentages are among adults reporting past-year methamphetamine use. Weighted percentages; bars represent 95% CI. *Among those with past-year methamphetamine use disorder. ±Past-month; all other variables are past-year. Adapted from Ref. .

Figure 3.

Percentage of drug-related treatment admissions reporting methamphetamine use in the United States, 2008–2017. Data source: 2008–2017 Treatment Episode Data Set. Any methamphetamine treatment admissions were defined as treatment admissions where methamphetamine was listed as a primary, secondary, or tertiary substance of use. Adapted from Ref. .