Abstract
BackgroundStimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that individuals who use methamphetamine require greater access to treatment, there is still little known about methamphetamine use and treatment among individuals who are already engaged in outpatient substance use treatment.ObjectivesTo characterize care-engaged individuals who use methamphetamine to guide harm reduction and treatment strategies.MethodsRetrospective cohort study of individuals at a large academic medical center in Massachusetts with ≥ 2 positive methamphetamine oral fluid toxicology tests between August 2019 and January 2020. We performed descriptive analysis of sociodemographic, medical, and drug use characteristics and a comparative analysis of injection methamphetamine use versus other routes of use.ResultsIncluded were 71 individuals [56 male (80%), 66 non-Hispanic white (94%), median age 36 (IQR 30–42)]. Nearly all had opioid (94%) and stimulant use disorder (92%). Most had (93%) or were (83%) being treated with medications for opioid use disorder, but few received pharmacologic treatment for methamphetamine use disorder (24%). None received contingency management treatment.People who inject methamphetamine (68%) were more likely to have a history of overdose (91% vs. 70%; p = 0.02), have HCV (94% vs. 52%; p < 0.01), use fentanyl (93% vs. 65%; p = 0.02), and engage in sex work (19% vs. 0%; p = 0.03) compared to those who used via other routes. Both groups had prevalent homelessness (88% vs. 73%; p = 0.15), incarceration (81% vs. 64%; p = 0.11), depression (94% vs. 87%; p = 0.34), and bacteremia (27% vs. 22%; p = 0.63).ConclusionsIndividuals in our study had high prevalence of polysubstance use, particularly concomitant methamphetamine and opioid use. Individuals who were well connected to substance use treatment for their opioid use were still likely to be undertreated for their methamphetamine use disorder and would benefit from greater access to contingency management treatment, harm reduction resources, and resources to address adverse social determinants of health.
Highlights
Stimulant use has escalated in the United States (US), following three earlier waves of prescription opioid, heroin, and fentanyl use, to forge a fourth wave of the opioid crisis [1,2,3]
People who inject methamphetamine (68%) were more likely to have a history of overdose (91% vs. 70%; p = 0.02), have Hepatitis C virus (HCV) (94% vs. 52%; p < 0.01), use fentanyl (93% vs. 65%; p = 0.02), and engage in sex work (19% vs. 0%; p = 0.03) compared to those who used via other routes
Individuals who were well connected to substance use treatment for their opioid use were still likely to be undertreated for their methamphetamine use disorder and would benefit from greater access
Summary
Stimulant use has escalated in the United States (US), following three earlier waves of prescription opioid, heroin, and fentanyl use, to forge a fourth wave of the opioid crisis [1,2,3]. The doubling of concomitant opioid and methamphetamine use between 2011 and 2017 suggest the rise of methamphetamine is connected to, not separate from, the opioid crisis [1]. From 2008 to 2017, primary heroin treatment admissions involving methamphetamine use increased in all US geographic regions, with a thirteen-fold increase in the Northeast [12]. Rising concomitant methamphetamine use has led to treatment challenges as individuals who use methamphetamine are less likely to be retained in opioid use treatment [13]. Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that individuals who use methamphetamine require greater access to treatment, there is still little known about methamphetamine use and treatment among individuals who are already engaged in outpatient substance use treatment
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