1. This cross-sectional study using survey data from individuals in US states with high overdose rates demonstrated that most individuals using drugs used both opioids and methamphetamines, and that nonfatal overdose rates were higher in co-users than those who used opioids or methamphetamines alone.
2. The findings from this study suggest a need to address opioid and methamphetamine use to mitigate the overdose crisis.
Evidence Rating Level: 3 (Average)
Study Rundown: Drug overdose in the US is on the rise despite increasing treatments for opioid use disorders and interventions to prevent overdoses. Methamphetamine is a known culprit of overdoses, often combined with opioids or on its own; yet, limited literature exists describing the use of methamphetamines in rural communities and its role in the national overdose crisis. This cross-sectional study estimated the prevalence of methamphetamine use in rural communities and investigated whether its use with opioids is associated with increased nonfatal overdoses. Cross-sectional surveys were completed by individuals who reported any past-30-day recreational injection drug use or non-injection opioid use from ten states in the US. Among respondents who reported using any methamphetamine or opioid, most used both; in fact, approximately 80% of individuals using drugs reported using methamphetamines in the past 30-days. Co-use of opioids and methamphetamine was associated with greater daily injection and a higher likelihood of past-30-day benzodiazepine use than those who used only opioids or methamphetamines. Respondents using both drugs had less access to substance use treatment and were more likely to have experienced an overdose than those who used only opioids or methamphetamines. Overall, this survey demonstrated that methamphetamine use might be intertwined with the opioid overdose epidemic. Most individuals in this study appear to be using both drugs, which was associated with higher rates of overdoses and increased difficulty accessing treatment. There is likely a need for interventions that address both opioid and methamphetamine use to help mitigate this ongoing crisis. One limitation of this study is that data was self-reported; the actual use of these drugs is likely higher, and recall abilities regarding overdoses may have been unreliable.
Click to read the study in JAMA
Relevant Reading: Evaluation of amphetamine-related hospitalizations and associated clinical outcomes and costs in the United States
In-Depth [cross-sectional study]: This study conducted a cross-sectional survey between January 2018 and March 2020 using individuals who use recreational drugs in rural US areas with high overdose rates (eight sites from ten states). Eligible individuals included those who reported any past 30-day injection drug use or non-injection opioid use “to get high.” Participants completed a 35- to 90-minute computer questionnaire; key questions included the use of opioids and methamphetamines in the past 30 days, any overdoses in the past 180 days, and total overdoses in their lifetimes. The main exposures were the use of methamphetamine alone, opioids alone, or co-use. The primary outcomes were the prevalence of methamphetamine use and any past-180-day nonfatal overdose. Co-use of methamphetamine and opioids was reported in 63% of participants. Additionally, co-use was associated with greater likelihood of injecting drugs (co-use: 65%, opioids alone: 41%, methamphetamine alone: 54%; c2/2 = 122.6; p< 0.001), of failing to access substance use treatment (co-use: 44%, opioids alone: 36%, methamphetamine alone: 30%; c2/2 = 33.8; p<0.001), and non-fatal overdose in the past 180 days (co-use: 22%, opioids alone: 14%, methamphetamine alone: 6%; c2/2 = 60.7; p< 0.001). Furthermore, the mean numbers of lifetime overdoses were: 2.39 for those with co-use, 1.70 for those who use opioids alone, and 1.07 for those who use methamphetamine alone (p< 0.001).
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