Is US heading towards another drug crisis? Meth-related deaths have increased five-fold in 7 years, says study
The sharpest rise in number of deaths has been among American Indians and Alaska Natives
While much attention has been given to the opioid crisis in the US, a methamphetamine crisis has been quietly, but actively, gaining steam, particularly among American Indians and Alaska Natives, who are disproportionately affected by several health conditions, suggest researchers. They found that overdose deaths from methamphetamine — a powerful, highly addictive stimulant that affects the central nervous system — surged over an eight-year period in the US.
Recent national data show that most people who use methamphetamine are between 25 and 54 years old, so the investigators limited their analysis to this age group. They examined data from this population as a whole. Results show that deaths involving methamphetamines rose sharply, from 1.8 to 10.1 per 100,000 men, and from 0.8 to 4.5 per 100,000 women. This represents a more than five-fold increase from 2011 to 2018.
While there have been rapid rises across all racial and ethnic groups, non-Hispanic American Indians and Alaska Natives had the highest death rates overall. According to the research that was conducted at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), deaths involving methamphetamines more than quadrupled among non-Hispanic American Indians and Alaska Natives from 2011-2018 (from 4.5 to 20.9 per 100,000 people) overall. There were sharp increases for both men (from 5.6 to 26.4 per 100,000 from 2011-2018) and women (from 3.6 to 15.6 per 100,000 from 2012-2018) in that group.
“The study found markedly high death rates among non-Hispanic American Indians and Alaska Natives, as well as a pattern of higher overdose death rates in men, compared to women within each racial/ethnic group. However, non-Hispanic American Indian and Alaska Native women had higher rates than non-Hispanic Black, Asian, or Hispanic men during 2012-2018, underscoring the exceptionally high overdose rates in American Indian and Alaska Native populations,” write authors in the report published in JAMA Psychiatry.
The analysis also indicates that non-Hispanic Black individuals had the fastest increases in death rates among men during 2011-2018. “This represents a worrying trend in a group that had previously experienced very low rates of methamphetamine overdose deaths,” the findings state.
The team obtained data from the 2011-2018 multiple cause-of-death records from the Centers for Disease Control and Prevention’s National Vital Statistics System. During 2011-2018, non-Hispanic White individuals had the second-highest rates, increasing from 2.2 to 12.6 per 100,000 among men, and from 1.1 to 6.2 per 100,000 among women. Rates among Hispanic individuals increased from 1.4 to 6.6 per 100,000 for men and from 0.5 to 2.0 per 100,000 for women.
What is methamphetamine?
Methamphetamine is a stimulant drug usually used as a white, bitter-tasting powder or a pill. Crystal methamphetamine is a form of the drug that looks like glass fragments or shiny, bluish-white rocks. According to NIDA, it is chemically similar to amphetamine, a drug used to treat attention-deficit/hyperactivity disorder (ADHD), and narcolepsy, a sleep disorder.
People can take methamphetamine by smoking, swallowing (pill), snorting, and injecting the powder that has been dissolved in water/alcohol. “Because the ‘high’ from the drug both starts and fades quickly, people often take repeated doses in a “binge and crash” pattern. In some cases, people take methamphetamine in a form of binging known as a ‘run,’ giving up food and sleep while continuing to take the drug every few hours for up to several days,” note researchers.
Some common names for methamphetamine include blue, crystal, ice, meth, chalk, fire, glass, and speed. “Methamphetamine increases the amount of the natural chemical dopamine in the brain. Dopamine is involved in body movement, motivation, and reinforcement of rewarding behaviors. The drug’s ability to rapidly release high levels of dopamine in reward areas of the brain strongly reinforces drug-taking behavior, making the user want to repeat the experience,” caution experts.
Methamphetamine use is linked to a range of serious health risks, including overdose deaths. Unlike for opioids, there are currently no medications approved by the US Food and Drug Administration (FDA) for treating methamphetamine use disorder or reversing overdoses. However, behavioral therapies such as contingency management therapy can be effective in reducing harms associated with the use of the drug, advise scientists. A recent clinical trial reported significant therapeutic benefits with the combination of naltrexone with bupropion in patients with methamphetamine use disorders, they add.
What do the researchers advise?
The investigators have recommended the urgent need to develop culturally tailored, gender-specific prevention and treatment strategies for methamphetamine use disorder to meet the unique needs of those who are most vulnerable to the growing overdose crisis. Long-term decreased access to education, high rates of poverty, and discrimination in the delivery of health services are among factors thought to contribute to health disparities for American Indians and Alaska Natives, they explain.
“American Indian and Alaska Native populations experience structural disadvantages but have cultural strengths that can be leveraged to prevent methamphetamine use and improve health outcomes for those living with addiction,” states Dr Nora D Volkow, senior author, and NIDA director.
The experts elaborate that shared decision-making between patient and healthcare provider and a “holistic approach to wellness are deeply rooted traditions” among some American Indian and Alaska Native groups and exist in the Indian health care system. Traditional practices, such as talking circles, in which all members of a group can provide an uninterrupted perspective, and ceremonies, such as smudging, have been integrated into the health practices of many tribal communities, they note.
The team says that leveraging traditions may offer a unique and culturally resonant way to promote resilience to help prevent drug use among young people. Development and implementation of other culturally appropriate and community-based prevention; targeting youth and families with positive early intervention strategies; and provider and community education may also aid prevention efforts among this population, they advise.
According to Dr Beth Han, who led the investigators, identifying populations that have a higher rate of methamphetamine overdose is a crucial step toward curbing the underlying methamphetamine crisis. “By focusing on the unique needs of individuals and developing culturally tailored interventions, we can begin to move away from one-size-fits-all approaches and toward more effective, tailored interventions,” suggests Dr Han.