Co-Involvement of Heroin, Fentanyl in Methamphetamine Mortality

Abstract and Introduction

Abstract

Objectives: To examine trends in methamphetamine-related mortality in the United States from 1999 to 2021 and the extent to which these deaths co-involved heroin or fentanyl.

Methods: We obtained final and provisional data from the CDC WONDER (Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research) multiple causes of death database for deaths that involved methamphetamine and deaths that involved both methamphetamine and heroin or fentanyl mong US residents aged 15 to 74 years. We plotted the age-adjusted methamphetamine-related mortality rate by year and quantified the proportion of deaths with heroin or fentanyl co-involvement. Finally, we used joinpoint regression to quantify trends in the methamphetamine mortality rate and proportion of deaths with heroin or fentanyl co-involvement.

Results: From 1999 to 2021, there was a 50-fold increase in the methamphetamine mortality rate, which was accompanied by an increasing proportion of deaths that co-involved heroin or fentanyl, peaking at 61.2% in 2021.

Conclusions: Unprecedented increases in methamphetamine-related mortality have occurred during the last decade, and an increasing proportion of these deaths co-involved heroin or fentanyl.

Public Health Implications: Stark increases in methamphetamine-related mortality and heroin or fentanyl co-involvement warrant robust harm reduction efforts, especially for people who engage in polysubstance use. (Am J Public Health. 2023;113(4):416–419. https://doi.org/10.2105/AJPH.2022.307212)

Introduction

A staggering increase in drug overdose deaths was observed in the United States in 2020.^[1] Moreover, the Centers for Disease Control and Prevention (CDC) reported that 2021 included the deadliest rolling 12-month period for drug overdose deaths on record thus far.^[2] Prepandemic data show upward trends in methamphetamine use,^[3] methamphetamine and heroin co-use,^[4] and methamphetamine-related mortality in the United States.^[3] In 2019, more than half of all psychostimulant overdose deaths also involved opioids,^[5] suggesting that the second (i.e., heroin) and third (i.e., fentanyl) waves of the opioid overdose crisis may be driving recent methamphetamine-related mortality. Given the steep increases in overall drug overdose mortality observed in 2020 and 2021,^[1,2] an updated examination of the trends in methamphetamine-related mortality is warranted. Moreover, it is critical to contextualize these deaths within the ongoing opioid overdose crisis by examining the extent to which methamphetamine-related mortality may be exacerbated by the co-involvement of heroin and fentanyl.

Qualitative data suggest that the co-use of methamphetamine and opioids is motivated by a desire to achieve specific embodied experiences not attained by methamphetamine or opioid use alone.^[6] Moreover, a recent qualitative study suggests that there is significant variation in the presentation and severity of stimulant-involved overdoses ("overamping"), which may limit the ability of people who use stimulants to recognize and respond to an overdose.^[7] The last 2 decades have also been marked by increased contamination of the unregulated drug supply with fentanyl and fentanyl-related analogs,^[8,9] suggesting that intentional and unintentional co-use may be catalyzing methamphetamine-related mortality in the United States. In this descriptive epidemiological analysis, we quantify the trends in methamphetamine-related mortality and the proportion of these deaths that also involved heroin or fentanyl, including time-sensitive changes not captured in prepandemic data.