1. This cross-sectional study using survey data from individuals in US states with high overdose rates demonstrated that most people who use drugs used both opioids and methamphetamines, and that rates of nonfatal overdoses were higher among co-users than among those who used opioids or methamphetamines alone. .
2. The results of this study suggest that addressing opioid and methamphetamine use is necessary to alleviate the overdose crisis.
Level of evidence assessment: 3 (Average)
Summary of the study: Drug overdoses in the United States are on the rise despite increased treatments for opioid use disorders and interventions to prevent overdoses. Methamphetamine is a known culprit of overdoses, often combined with opioids or alone; Yet there is little literature describing methamphetamine use 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 was associated with an increase in non-fatal overdoses. Cross-sectional surveys were conducted of people who reported having used recreational injection drugs or non-injection opioids in the past 30 days in ten states in the United States. Among respondents who reported using methamphetamine or opioids, most used both; in fact, about 80% of drug users reported using methamphetamine in the past 30 days. Co-use of opioids and methamphetamine was associated with greater daily injecting and a higher likelihood of benzodiazepine use in the past 30 days than those who used only opioids or methamphetamines. Respondents who used both drugs had less access to addiction treatment and were more likely to have overdosed than those who used only opioids or methamphetamines. Overall, this investigation demonstrated that methamphetamine use may be linked to the opioid overdose epidemic. Most people in this study appear to use both drugs, which has been 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 alleviate this ongoing crisis. One of the limitations of this study is that the data was self-reported; actual use of these drugs is likely higher, and overdose recall capabilities 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 of individuals who use recreational drugs in rural areas of the United States with high overdose rates (eight sites in ten states). Eligible people included those who said they had used injection drugs or non-injection opioids in the past 30 days “to get high”. Participants completed a 35- to 90-minute computer questionnaire; key questions included opioid and methamphetamine use in the past 30 days, any overdoses in the past 180 days, and total lifetime overdoses. The main exposures were the use of methamphetamine alone, opioids alone or concomitant consumption. The primary outcomes were prevalence of methamphetamine use and any non-fatal overdose in the past 180 days. Co-use of methamphetamine and opioids was reported in 63% of participants. In addition, co-use was associated with a greater likelihood of injecting drugs (co-use: 65%, opioids alone: 41%, methamphetamine alone: 54%; c2/2 = 122.6; p2/2 = 33.8; p2/2 = 60.7; pp
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