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. 2022 Aug 1;5(8):e2226544.
doi: 10.1001/jamanetworkopen.2022.26544.

Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities

P Todd Korthuis  1   2 , Ryan R Cook  1 , Canyon A Foot  1 , Gillian Leichtling  3 , Judith I Tsui  4 , Thomas J Stopka  5 , Judith Leahy  6 , Wiley D Jenkins  7 , Robin Baker  2 , Brian Chan  1 , Heidi M Crane  4 , Hannah L Cooper  8 , Judith Feinberg  9   10 , William A Zule  11 , Vivian F Go  12 , Angela T Estadt  13 , Robin M Nance  4 , Gordon S Smith  14 , Ryan P Westergaard  15 , Brent Van Ham  7 , Randall Brown  16 , April M Young  17   18
Affiliations

Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities

P Todd Korthuis et al. JAMA Netw Open. .

Abstract

Importance: Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities.

Objective: To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses.

Design, setting, and participants: From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022.

Exposures: Use of methamphetamine alone, opioids alone, or both.

Main outcomes and measures: Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses.

Results: Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ22 = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone.

Conclusions and relevance: These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Korthuis reported receiving grants from the National Institute on Drug Abuse (NIDA; UG1DA01581) and the National Center for Advancing Translational Sciences (U01TR002631) during the conduct of the study and serving as principal investigator for National Institutes of Health (NIH)–funded trials that accepted donated study medications from Alkermes (extended-release naltrexone) and Indivior (sublingual buprenorphine). Dr Leichtling reported receiving grants from NIDA (NIH) during the conduct of the study. Dr Chan reported that part of their clinical work is as an addiction medicine clinician in primary care and detoxification-stabilization treatment settings. Dr Crane reported receiving grants from NIH during the conduct of the study and grants from the Agency for Healthcare Research and Quality and ViiV Healthcare outside the submitted work. Dr Feinberg reported receiving grants from the University of Pittsburgh Magee-Women’s Foundation (original funding to the university from Gilead Sciences) and personal fees from ViiV Healthcare outside the submitted work. Dr Zule reported receiving grants from NIDA during the conduct of the study. Dr Estadt reported receiving grants from NIDA (1F31DA054752-01A1) during the conduct of the study. Dr Nance reported receiving grants from NIDA during the conduct of the study. Dr Westergaard reported receiving grants from NIDA during the conduct of the study and serving as Chief Medical Officer for the Bureau of Communicable Diseases at the Wisconsin Department of Health Services. Dr Brown reported receiving grants from NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Probability of Methamphetamine (MA) Overdose in Last 180 Days and Adjusted Mean Lifetime Overdoses
Circles denote means and error bars denote 95% CIs. aOR indicates adjusted odds ratio; aRR, adjusted rate ratio.
See this image and copyright information in PMC

References

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