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• Posted February 21, 2023

U.S. Deaths Involving Meth Are Skyrocketing, Fentanyl a Big Factor

Deaths from methamphetamine among Americans increased 50-fold between 1999 and 2021, a chilling new study reports.

Most of these deaths also involved heroin or fentanyl, according to researchers.

"The staggering increase in methamphetamine-related deaths in the United States is largely now driven by the co-involvement of street opioids," said lead researcher Rachel Hoopsick, an assistant professor of epidemiology at the University of Illinois at Urbana-Champaign.

"Mixing methamphetamine and opioids isn't a new phenomenon," she said. "Although there has been an increase in the popularity of using these types of substances together, what has truly changed is the toxicity of the unregulated street drug supply, predominantly of fentanyl and other synthetic opioids. I believe that this is the primary driver of the increase in deaths."

But that's not the only factor that contributes to fatal meth overdoses, Hoopsick added. Methamphetamine overdose can be hard to recognize. While many people can recognize the signs of an opioid overdose, the signs of meth overdose are variable in terms of presentation and severity. That may contribute to the likelihood of a fatal overdose.

Signs of a meth overdose include anger, aggressiveness and restlessness; confusion; dark urine; dizziness and fainting; fast breathing; irregular heartbeat; muscle cramps, pain or stiffness; seeing, hearing or feeling things that are not there; seizures; sweating; tremor; unusual tiredness or weakness; stomach cramps and vomiting, according to the Mayo Clinic.

Hoopsick doubts the epidemic of drug deaths in the United States will abate anytime soon. "Humans have been using substances for longer than we have historical records," she said.

"A number of behavioral studies suggest that methamphetamine use is increasing in the United States, particularly among people who use other substances," Hoopsick said. "Yet, the more strict our policies become around illicit drugs, the more deadly the unregulated supply becomes. When there aren't safe, regulated sources of substances for people to use, it fuels organized crime and the development of more potent street drugs, particularly illicitly manufactured fentanyl."

For the study, she and study co-author R. Andrew Yockey, an assistant professor of biostatistics and epidemiology at the University of North Texas Health Science Center at Fort Worth, reviewed data from the U.S. Centers for Disease Control and Prevention.

In 1999, 608 deaths were attributed to meth. By 2021, the number had skyrocketed to nearly 52,400.

In 2021, 61% of fatal meth overdoses also involved heroin or fentanyl, the study found.

Much of the increase in meth-related deaths happened between 2010 and 2021, Hoopsick and Yockey noted. It shows no sign of easing.

Although meth itself can be deadly, it's the increased availability of highly potent illicit fentanyl that seems to underlie the wave of overdose deaths, Hoopsick said. Some people who use meth think adding opioids will prevent or reverse an overdose. That, she said, is a myth and can be a deadly combination.

Hoopsick said more robust treatment services are needed.

"There is a real lack of treatment options for folks with stimulant use disorder," she said. "Very few folks with stimulant use disorder access treatment, compounded by barriers to care, stigma and limited evidence-based treatment options for stimulant use disorder. Unlike opioid and alcohol use disorder, there are no FDA-approved medications to manage stimulant use disorder. We need more robust harm-reduction services."

Just as abstinence-based approaches don't work in sex education, they don't work in reducing drug-related harms either, Hoopsick said.

"Syringe service programs, providing fentanyl test strips, making sure people have access to free naloxone or Narcan, safe consumption sites so people don't have to use alone, and even safe supply initiatives that provide tested drugs in known quantities and potencies can help," she said.

While there is a "tremendous amount of evidence" to support the effectiveness of harm-reduction services, Hoopsick said there is a lack of political will to make them legal and accessible.

Linda Richter, vice president for prevention research and analysis at the Partnership to End Addiction, reviewed the findings.

She noted that in 2021, nearly 2 million people ages 21 and older reported using methamphetamine in the past month, according to the National Survey on Drug Use and Health.

"Methamphetamine has become increasingly available, especially in communities of color, and it is a highly addictive drug," Richter said. "The recent opioid epidemic led to a much-needed focus on opioids, but less attention and resources went to addressing the broader addiction crisis that was simultaneously brewing, especially in relation to stimulants like methamphetamine."

Richter said more needs to be done to curb supply of the drug. But, she added, the evidence is clear that reducing demand through effective and early prevention, addressing key factors that drive use of meth and other drugs and providing effective and affordable addiction care is a more sustainable approach than trying to fight illegal trafficking.

"This country has a history of focusing virtually exclusively on one particular drug at a time, rather than on recognizing that all forms of substance use are driven by similar and overlapping factors, that most people who used drugs use more than one type, and that the interventions that work to prevent and treat one form of substance misuse or addiction are similar across all the misused substances," she said.

"The fentanyl crisis must be curbed through better interdiction and more wide-scale public awareness of the dangers of taking any non-prescribed drug, as upwards of 60% of the confiscated illegal drug supply is contaminated with deadly doses of fentanyl," Richter said.

The report was recently published online in the American Journal of Public Health.

More information

The Mayo Clinic provides signs of a methamphetamine overdose.

SOURCES: Rachel Hoopsick, PhD, MS, MPH, assistant professor, epidemiology, University of Illinois at Urbana-Champaign; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction, New York City; American Journal of Public Health, Feb. 2, 2023, online