Methamphetamine-related Harms Research Articles

20-year trends in Australian methamphetamine-related deaths, 2001–2020

BackgroundOver the past two decades methamphetamine-related harms have increased in Australia. Previous analysis of methamphetamine-related deaths has covered limited timeframes, and largely focused on drug-toxicity deaths. This paper examines long-term trends in methamphetamine-related deaths over 20 years, including deaths due to a range of specific causes. MethodsDescriptive analyses were conducted on Australian methamphetamine-related deaths (2001–2023) by cause, extracted from the National Coronial Information System, an online database containing deaths reported to coroners in Australia and New Zealand. Joinpoint trend analyses were used to assess changes over time between 2001 and 2020 (with data from 2021 to 2023 likely incomplete and thus excluded). ResultsUnintentional drug toxicity was the cause of 49.8 % of methamphetamine-related deaths, intentional self-harm (including toxicity) 23.3 %, unintentional injury 15.1 %, natural causes 9.6 %, and assaults 2.3 %. Between 2001 and 2020, joinpoint analysis showed three trend change points among all-cause methamphetamine-related mortality rates, resulting in four distinct periods: two periods where they increased (2001–2006 – annual percentage change (APC) = 15.4 %; 2009–2016 – APC 25.5 %), and two where they decreased (2006–2009 – APC = –11.8 %; 2017–2020 – APC = –2.9 %). Similar patterns were evident among rates of intentional self-harm and unintentional injury. Deaths caused by unintentional drug toxicity saw two trend change points (2011, 2016), and rates increased across all three periods. Natural cause deaths had three trend change points (2007, 2010, 2015), and rates continued to rise after 2015, largely driven by increases in circulatory diseases. ConclusionCause-specific models highlighted diverse trends. Recent trends show unintentional drug toxicity deaths have slightly increased, intentional self-harm stabilised, and unintentional injury and assault deaths have declined. Deaths from natural causes involving methamphetamine continued to increase, highlighting a public health concern and a potential need for early circulatory disease screening among people who use methamphetamine.

Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data

IntroductionRising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes...

'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs.

IntroductionFirst Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood.MethodsWe conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms.ResultsFindings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing.Discussion and ConclusionsFirst Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.

Patterns and Characteristics of Methamphetamine Use Among Adults - United States, 2015-2018.

Methamphetamine is a highly addictive central nervous system stimulant. Methamphetamine use is associated with a range of health harms, including psychosis and other mental disorders, cardiovascular and renal dysfunction, infectious disease transmission, and overdose (1,2). Although overall population rates of methamphetamine use have remained relatively stable in recent years (3), methamphetamine availability and methamphetamine-related harms (e.g., methamphetamine involvement in overdose deaths and number of treatment admissions) have increased in the United States* (4,5); however, analyses examining methamphetamine use patterns and characteristics associated with its use are limited. This report uses data from the 2015-2018 National Surveys on Drug Use and Health (NSDUHs) to estimate methamphetamine use rates in the United States and to identify characteristics associated with past-year methamphetamine use. Rates (per 1,000 adults aged ≥18 years) for past-year methamphetamine use were estimated overall, by demographic group, and by state. Frequency of past-year use and prevalence of other substance use and mental illness among adults reporting past-year use were assessed. Multivariable logistic regression examined characteristics associated with past-year use. During 2015-2018, the estimated rate of past-year methamphetamine use among adults was 6.6 per 1,000. Among adults reporting past-year methamphetamine use, an estimated 27.3% reported using on ≥200 days, 52.9% had a methamphetamine use disorder, and 22.3% injected methamphetamine. Controlling for other factors, higher adjusted odds ratios for past-year use were found among men; persons aged 26-34, 35-49, and ≥50 years; and those with lower educational attainment, annual household income <$50,000, Medicaid only or no insurance, those living in small metro and nonmetro counties,† and those with co-occurring substance use and co-occurring mental illness. Additional efforts to build state and local prevention and response capacity, expand linkages to care, and enhance public health and public safety collaborations are needed to combat increasing methamphetamine harms.

Crystal methamphetamine's impact on frontline emergency services in Victoria, Australia

BackgroundThe use of crystal methamphetamine is a growing problem in Australia. Methamphetamine users can suffer adverse physical health effects, psychotic symptoms and methamphetamine-related aggressive behaviour. The increasing use and related harms of crystal methamphetamine is presenting serious problems for frontline emergency responders. MethodsA population-based retrospective analysis was undertaken of data collected by Ambulance Victoria describing crystal methamphetaminerelated events attended by ambulance across Victoria over six financial years from 2011/12 to 2016/17. ResultsMethamphetamine-related events attended by Victoria Ambulance paramedics significantly increased from 2011/12 to 2016/17, particularly in regional Victoria. The most frequent age group requiring ambulance attendance is 25–39 years. The proportion of events requiring police coattendance significantly increased, as did transportation to emergency department/hospital. ConclusionThe substantial increases in methamphetamine-related events attended by ambulance indicate the need for increased resources and support for paramedics, particularly in regional/rural areas. The large increase among young people aged 15–24 years indicates a need for policy action on prevention, harm reduction and expanded treatment services to reduce health problems and methamphetamine-related harms.

HDL2- and HDL3- Mediated Transport of Sphingosine-1-phosphate in Mixed Dyslipidemia: Effect of Statin Treatment

The use of crystal methamphetamine is a growing problem in Australia. Methamphetamine users can suffer adverse physical health effects, psychotic symptoms and methamphetamine-related aggressive behaviour. The increasing use and related harms of crystal methamphetamine is presenting serious problems for frontline emergency responders.A population-based retrospective analysis was undertaken of data collected by Ambulance Victoria describing crystal methamphetaminerelated events attended by ambulance across Victoria over six financial years from 2011/12 to 2016/17.Methamphetamine-related events attended by Victoria Ambulance paramedics significantly increased from 2011/12 to 2016/17, particularly in regional Victoria. The most frequent age group requiring ambulance attendance is 25–39 years. The proportion of events requiring police coattendance significantly increased, as did transportation to emergency department/hospital.The substantial increases in methamphetamine-related events attended by ambulance indicate the need for increased resources and support for paramedics, particularly in regional/rural areas. The large increase among young people aged 15–24 years indicates a need for policy action on prevention, harm reduction and expanded treatment services to reduce health problems and methamphetamine-related harms.

\u201cJust not all ice users do that\u201d: investigating perceptions and potential harms of Australia\u2019s Ice Destroys Lives campaign in two studies

BackgroundIn 2015, the Australian government launched the media campaign Ice Destroys Lives targeting crystal methamphetamine use. Previous research indicates mass media campaigns may have harmful effects for people engaged in drug use. This study investigated perceptions and harms of Ice Destroys Lives among adults with a history of injecting drugs and young people.MethodsThis analysis includes data from two studies: an online questionnaire with young people and in-depth interviews with adults who use crystal methamphetamine. Young people from Victoria, Australia, were recruited through Facebook. We collected data on drug use, campaign recognition and behaviours. Participants who recognised the campaign indicated whether they agreed with five statements related to Ice Destroys Lives. We compared campaign perceptions between young people who reported ever using crystal methamphetamine and those who did not. Adults who use crystal methamphetamine were sampled from the Melbourne injecting drug user cohort study. We asked participants if they recognised the campaign and whether it represented their experiences.ResultsOne thousand twenty-nine young people completed the questionnaire; 71% were female, 4% had used crystal methamphetamine and 69% recognised Ice Destroys Lives. Three quarters agreed the campaign made them not want to use ice. Ever using crystal methamphetamine was associated with disagreeing with three statements including this campaign makes you not want to use ice (adjusted odds ratio (AOR) = 4.3, confidence interval (CI) = 1.8–10.0), this campaign accurately portrays the risks of ice use (AOR = 3.2, CI = 1.4–7.6) and this campaign makes you think that people who use ice are dangerous (AOR = 6.6, CI = 2.2–19.8). We interviewed 14 people who used crystal methamphetamine; most were male, aged 29–39 years, and most recognised the campaign. Participants believed Ice Destroys Lives misrepresented their experiences and exaggerated “the nasty side” of drug use. Participants felt the campaign exacerbated negative labels and portrayed people who use crystal methamphetamine as “violent” and “crazy”.ConclusionIn our study, Ice Destroys Lives was widely recognised and delivered a prevention message to young people. However, for people with a history of crystal methamphetamine use, the campaign also reinforced negative stereotypes and did not encourage help seeking. Alternative evidence-based strategies are required to reduce crystal methamphetamine-related harms.

Crystalline methamphetamine use and methamphetamine-related harms in Australia.

Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia. Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate. The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010. The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170].

How is methamphetamine typically purchased and used in Melbourne, Australia? Reports from a cohort of people who inject drugs

Background: Methamphetamine-related harms have been increasing in Melbourne, Australia, yet little is known of how users interact with the drug market. We describe methamphetamine purchases and use as reported by a Melbourne-based cohort of people who inject drugs (PWID).Methods: A total of 2862 interviews from 757 participants of the Melbourne Injecting Drug User Cohort Study between April 2008 and February 2015 were used to generate descriptive statistics for the: size, search time and setting (e.g. house, street) of methamphetamine purchases, and the percentage that were shared; and the time of day, time between purchasing and using and setting of methamphetamine use.Results: No meaningful differences were observed between the powder and crystal methamphetamine markets. The most frequently purchased amount of methamphetamine was $100 with much larger transactions common; however 42% of purchases were shared, most commonly 50/50 with a partner or friend. The median time to obtain methamphetamine was 20 minutes (interquartile range (IQR) 5–30 minutes) and the median time between purchasing and using methamphetamine was 5 minutes (IQR 5–10 minutes). Most purchases were used between 10 am and 2 pm (43% of purchases), but 33% were used outside of business hours. Both purchasing and using methamphetamine occurred more frequently in houses than public settings.Conclusions: It was common for PWID in our sample to obtain >$100 of methamphetamine with a partner or friend, with relatively little search time. Support services for methamphetamine users may need to increase their operating hours to adapt to the large amount of use occurring outside of business hours.

New College policy and advocacy work contributes to addressing methamphetamine-related harms in Australia and New Zealand.

New College policy and advocacy work contributes to addressing methamphetamine-related harms in Australia and New Zealand.

‘Ice epidemic’? Trends in methamphetamine use from three Victorian surveillance systems

Introduction and Aims: Victorian media have been reporting a widespread ‘ice crisis’. This concern arises predominantly from anecdotal information and data showing increasing rates of methamphetamine-related harms.We triangulate three data sources to investigate whether a possible increase in methamphetaminerelated harms has been driven by an actual increase in methamphetamine (speed powder/ice/crystal) use. Design and Methods: We analysed three, annual, cross-sectional Melbourne-based drug monitoring systems.The Big Day Out (BDO) surveys young people at a music festival. The Ecstasy and Related Drugs Reporting System (EDRS) targets regular psychostimulant users. The Illicit Drug Reporting System (IDRS) interviews people who inject drugs.Trends in prevalence were assessed using Chi test for trend. Trends in frequency of use were assessed using Poisson regression. Results: The percentages reporting recent methamphetamine use were 8% among BDO attendees (n/N = 825/9582), 75% among EDRS participants (n/N = 452/601) and 65% among IDRS participants (n/N = 587/898). The BDO found a non-linear decrease over time in the percentage recently using methamphetamine. EDRS and IDRS data showed no significant change in prevalence of use, but the EDRS showed an increase in frequency of use between 2008 and 2014 (P < 0.01). Discussion and Conclusions: These samples are not representative of the general population and are not reflective of rural populations. Methamphetamine use prevalence among the three serial cross-sectional samples remained stable from 2008–2013/14. Evidence of increasing use frequency may explain some trends in rising harms. Research that accurately characterises methamphetamine use will allow attention to focus on effectively preventing methamphetamine-related harms. Implications for Practice or Policy: While not wanting to underplay the potential adverse effects of methamphetamine use, it is important that government takes an evidence-based response to this issue. The media, policy makers, and practitioners should be aware that increased harm is not necessarily indicative of increased population-level methamphetamine use.

High-frequency drug purity and price series as tools for explaining drug trends and harms in Victoria, Australia.

Methamphetamine-related harms in Victoria have increased recently in the context of stable or declining use prevalence. We determine how changes in price and purity of methamphetamine compared to other drugs such as heroin may, in part, explain these divergent patterns. Detailed methamphetamine and heroin purchase price data from 2152 participant interviews from the Melbourne Injecting Drug User cohort study were used to generate drug price series for the period January 2009-June 2013. Data on drug purity from 8818 seizures made within Victoria were used to generate drug purity series during the same period. Purity-adjusted price data for methamphetamine and heroin were obtained for the period 2009-13 by combining the two data sets. While the average purity of heroin seizures remained consistent and low, the average purity of powder and of crystal methamphetamine seizures increased from 12% [95% confidence interval (CI) = 10-14%] to 37% (95% CI = 20-54%) and 21% (95% CI = 18-23%) to 64% (95% CI = 60-68%), respectively. Crystal methamphetamine purity was bimodal, with observations generally less than 20% or greater than 70%. The average unadjusted price per gram for heroin decreased from $374 (95% CI = $367-381) to $294 (95% CI = $280-308), powder methamphetamine did not change significantly from $252 (95% CI = $233-271), and crystal methamphetamine increased substantially from $464 (95% CI = $416-511) in 2009 to $795 (95% CI = $737-853) in 2011. This increase was offset by an even greater increase in purity, meaning the average purity-adjusted price per gram declined. Furthermore, pure prices of both methamphetamine forms were similar, whereas their unadjusted prices were not. The pure price of heroin fluctuated with no ongoing trends. Decreases in methamphetamine purity-adjusted price along with the bimodality of crystal methamphetamine purity may account for some of the recent increase in methamphetamine-related harm. For a given amount spent, methamphetamine purchase power has increased and the presence of extreme purity variations may challenge individuals' control of consumption.

An exploration of self-perceived non-problematic use as a barrier to professional support for methamphetamine users

BACKGROUND: Despite low levels of motivation and perceived need for professional support among methamphetamine users, there is a lack of research examining self-perceptions of non-problematic use and their relationship with methamphetamine use patterns and experience of associated harms. METHOD: Regular methamphetamine users (N=255) were recruited in metropolitan Melbourne, Australia, during 2010 and administered a structured questionnaire. RESULTS: Forty-one percent of participants reported that their use was not problematic or harmful enough to warrant accessing professional support. In multivariate logistic regression analyses those who perceived their use as non-problematic generally engaged in less risky methamphetamine use patterns, experienced fewer associated harms and were more likely to be employed than those not perceiving their use as non-problematic. However, half of the 'non-problematic' participants were classified as methamphetamine-dependent using the severity of dependence scale and most reported recently experiencing significant methamphetamine-related harms, suggesting a degree of unrecognised need. CONCLUSION: Our findings highlight the issue of perceived need as a key barrier to methamphetamine service access and the sustaining of such barriers in individuals over time. They emphasise the importance of addressing the service needs of different methamphetamine using populations. Language: en

Factors associated with professional support access among a prospective cohort of methamphetamine users

Encouraging out-of-treatment methamphetamine users who engage in problematic use patterns to initiate access of drug treatment and other health and support services is a key focus of drug policy. We followed a community-recruited cohort (N=255) of regular methamphetamine users in Melbourne, Australia, to investigate patterns of engagement with professional support for methamphetamine use and/or associated harms over 12months. Multivariate logistic regression identified factors independently associated with initiating contact with services during follow-up. Generalised estimating equations identified factors associated with current (at the time of interview) service access. General practitioners were the most common source of professional support during follow-up (24%). Overall, service utilisation was associated with riskier methamphetamine use patterns (e.g., injecting), professional support access for other issues (e.g., mental health), and greater experience of methamphetamine-related harms (e.g., adverse social consequences). These findings provide insights to inform strategies that will improve treatment initiation and retention by methamphetamine users.

All-cause mortality among individuals with disorders related to the use of methamphetamine: A comparative cohort study

BackgroundUnderstanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (US) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking. MethodsThe current study identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n=74,139), alcohol- (n=582,771), opioid- (n=67,104), cannabis- (n=46,548), or cocaine-related disorders (n=48,927), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) were generated. ResultsThe methamphetamine cohort had a higher SMR (4.67, 95% CI 4.53, 4.82) than did users of cocaine (2.96, 95% CI 2.87, 3.05), alcohol (3.83, 95% CI 3.81, 3.85), and cannabis (3.85, 95% CI 3.67, 4.03), but lower than opioid users (5.71, 95% CI 5.60, 5.81). ConclusionsOur study demonstrates that individuals with methamphetamine-use disorders have a higher mortality risk than those with diagnoses related to cannabis, cocaine, or alcohol, but lower mortality risk than persons with opioid-related disorders. Given the lack of long-term cohort studies of mortality risk among individuals with methamphetamine-related disorders, as well as among those with cocaine- or cannabis-related conditions, the current study provides important information for the assessment of the comparative drug-related burden associated with methamphetamine use.

Trends in Primary Methamphetamine-Related Admissions to Youth Residential Substance Abuse Treatment Facilities in Canada, 2005–2006 and 2009–2010

During the last decade, methamphetamine use and issues surrounding its toxicity have triggered major concern in the Canadian government, leading to significant changes in drug policy and funding strategies to limit the societal impact of methamphetamine-related harms. This concern appears justified by research which found in 2005-2006 that 21% of all youth admissions to inpatient substance abuse treatment centres in Canada were due primarily to methamphetamine abuse. Given these patterns of treatment use and targeted governmental initiatives, an open question is whether the demand for methamphetamine treatment found in 2005-2006 has decreased. Our study aims to provide follow-up estimates of admissions for 2009-2010, as well as important trend information for these periods. We developed a comprehensive list of all Canadian residential youth substance abuse treatment facilities. The executive director of each facility was asked about the site's annual caseload, and the proportion of cases primarily due to methamphetamine abuse within the past 12 months. Our survey data for the periods of 2005-2006 and 2009-2010 show marked reductions in admissions. In 2009-2010, we found that about 6% of all admissions were due primarily to methamphetamine abuse, a substantial drop from the 21% reported in our 2005-2006 study. Our data show a significant national reduction in methamphetamine-related admissions. Other reports show that methamphetamine-related treatment admissions in the United States and Mexico declined sharply during 2005-2008, reportedly in association with Mexico's methamphetamine precursor chemical controls, raising the possibility that the controls may also be associated with the declines reported here.

THE HOLY GRAIL OF SUPPLY CONTROL: HAVE WE FOUND THE EVIDENCE?

Cunningham and colleagues provide what is probably the most compelling evidence to date that precursor regulations, or indeed any supply control strategy, can have significant impacts on the retail market for illicit drugs. This research is particularly interesting if considered in the context of Cunningham's earlier work, which has shown that precursor regulations are followed by significant reductions in methamphetamine-related arrests and hospital admissions. Linking these reductions to changes in the retail market for illicit methamphetamine (i.e. decreased purity), and showing that precursor regulations impact specifically on methamphetamine, fortifies the argument that precursor regulations are responsible for reductions in methamphetamine-related harms. This research is ground-breaking, in that it paves the way towards a more sophisticated analysis of how supply reduction interventions impact on harms from illicit drug use.