Story at a glance
- Co-use of methamphetamine and opioids pose challenges for patients and providers alike, especially in rural regions of the United States.
- These individuals are less likely to have access to opioid treatment medications and mental health care.
- New data details the extent to which methamphetamine has moved eastward across the United States and permeated rural communities.
As the United States gears up for what is expected to be an even worse wave of opioid overdoses, new research published in JAMA Network Open shows nearly 4 in 5 drug users in rural America report using methamphetamine, a substance often overlooked in the epidemic.
Individuals can take methamphetamine, a synthetic stimulant, by itself, as well as in conjunction with opioids or laced with fentanyl.
To better understand how frequently methamphetamine and opioids are associated with non-fatal overdoses in rural communities, researchers surveyed more than 3,000 individuals in rural counties with high overdose rates across Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia and Wisconsin.
Seventy-nine percent of those who used drugs in the past 30 days reported using methamphetamine, while non-fatal overdoses were most common among those using both methamphetamine and opioids (22 percent). In comparison, those using opioids alone had a 14 percent non-fatal overdose rate, while methamphetamine use alone saw a 6 percent rate.
Prevalence of methamphetamine use was highest in Oregon, where more than 95 percent of drug users reported use within the past month.
Just 17 percent of individuals who used methamphetamine alone reported having naloxone, an overdose reversal drug, and those using both substances said they had the least access to treatment.
Data were collected between January 2018 and March 2020. The majority (85 percent) of individuals were white and 57 percent were male, with a mean age of 36.
These trends align with those suffering “Deaths of Despair,” or deaths resulting from drug overdoses, suicide and alcoholic liver disease, that disproportionately affect white men in the United States and are driven in large part by economic misery.
However, “participants with concomitant opioid and methamphetamine use were younger and more commonly reported American Indian or Alaskan Native race,” authors wrote, underscoring the importance of culturally tailored interventions for these vulnerable populations.
Combined use was also more common among individuals who reported recent homelessness.
Between April 2020 and March 2021, 100,306 individuals died from overdoses in the U.S., the largest number ever reported in a 12-month period, researchers wrote.
“Methamphetamine use has been endemic in the western US for decades, particularly in rural communities where use is more prevalent than in metropolitan areas,” they added. “Recent data suggest that methamphetamine use has spread to other regions of the US where it is associated with unstable housing, low income, and rural residence.”
Individuals in rural areas also tend to have limited access to opioid use disorder medications and mental health care services.
“As fentanyl continues to replace heroin and adulterate the methamphetamine supply, early response systems to track nonfatal overdoses and implement rapid prevention interventions are urgently needed to decrease overdose deaths,” researchers stressed.
Increased distribution of naloxone and fentanyl test strips could help reduce harms in this population, as currently more than half of U.S. counties do note have a prescriber for naloxone “leaving 30 million people in those counties without access to treatment.”