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The number of overdose deaths involving psychostimulants besides cocaine -- primarily methamphetamine -- increased by 180% in recent years, a cross-sectional study from the National Institute on Drug Abuse (NIDA) found.

Using data from both the National Surveys on Drug Use and Health (NSDUH) and the National Vital Statistics System Multiple Cause of Death, overdose deaths increased from 5,526 in 2015 to 15,489 in 2019 (P<0.001 for trend), reported Beth Han, MD, PhD, MPH, and colleagues.

Past-year methamphetamine use increased by a weighted 43% over the 4-year period -- from 1.4 million (95% CI 1.2-1.6 million) to 2.0 million (95% CI 1.7-2.3 million, P=0.002), as described in .

The number of people who self-identified as frequent methamphetamine users also increased by 66% -- from 615,000 in 2015 (95% CI 512,000-717,000) to 1,021,000 in 2019 (95% CI 860,000-1,183,000; P=0.002).

Analyses of the NSDUH data -- which included 195,711 respondents ages 18 to 64 -- found that the combined use of methamphetamine and cocaine increased by 60% -- from 402,000 (95% CI 306,000-499,000) to 645,000 (95% CI 477,000-813,000; P=0.001). This trend, the team said, mirrors similar drug use patterns shown in about the rise of users of both methamphetamine and opioids.

"Expansion of community-based interventions to reduce injection drug use-associated harms and overdoses, such as comprehensive Syringe Services Programs, could help mitigate overdose risks and the additional spread of infectious diseases," Han and co-authors wrote.

They noted that since 2017, individuals who reported past-year methamphetamine use also reported associated high-risk behaviors such as having methamphetamine use disorder (MUD) and use through injection -- more frequently than they did lower-risk use patterns. This suggests an evolving pattern of riskier methamphetamine use behaviors among U.S. adults, the team suggested.

"What makes these data even more devastating is that currently, there are no approved medications to treat methamphetamine use disorder," said co-author Emily Einstein, PhD, chief of NIDA's Science Policy Branch, in a . "NIDA is working to develop new treatment approaches, including safe and effective medications urgently needed to slow the increase in methamphetamine use, overdoses, and related deaths."

The demographics of those who reported using methamphetamine shifted from 2015 to 2019, the analysis showed. MUD without the use of injection increased 10-fold for Black Americans (0.06% to 0.64%, P<0.001), tripled among white individuals (0.28% to 0.78%, P<0.001), and more than doubled for those who identified as Hispanic (0.39% to 0.82%, P<0.001).

Similar upward trends were found among sexual orientation subgroups, the researchers said: The prevalence of MUD without injection more than tripled among heterosexual women (0.24% to 0.74%, P<0.001) and among gay or bisexual women (0.21% to 0.71%, P <0.001), and more than doubled among straight men (0.29% to 0.79%, P<0.001) and gay or bisexual men (0.29% to 0.80%, P=0.007).

The direction of the findings, coupled with showing a growth of methamphetamine use during the pandemic, indicates a potential for the trend to accelerate in the years since 2019, Han and co-authors said.

Overall, 104,408 of the NSDUH respondents identified as women (coming to a weighted percentage of 50.9%), 114,248 were white (60.6%), 25,389 were Black (12.6%), and 35,686 were Hispanic (18%).

Study limitations, the researchers said, included the cross-sectional nature of the NSDUH data, which precluded drawing causal inferences; the self-report survey style, which is subject to recall and "social desirability" bias; and the likelihood that the prevalence of methamphetamine use may have been underestimated, since NSDUH does not include homeless, incarcerated, or institutionalized individuals.

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