Methamphetamine trends and treatments
By Rebecca Martinez, RN, MS, FNP-C
Methamphetamine, the central nervous system stimulant with a reputation for being highly-addictive, has always been a hot topic in the media and increasingly so in the past year. Reports of overdose deaths from methamphetamine contaminated with fentanyl, communities seeing “waves of violence and homelessness as meth returns”, and an influx of “meth 2.0” from Mexico that is stronger and cheaper-than-ever sensationalize the use of methamphetamine in the U.S.
So what DO we know from the data?
Earlier this year, the Morbidity and Mortality Weekly Report (MMWR) released Patterns and Characteristics of Methamphetamine Use Among Adults - United States, 2015–2018. This report used data from the National Surveys on Drug Use and Health (NSDUHs), which estimated methamphetamine use rates in the United States based on in-person interviews with 170,000 individuals. Based on their findings, 1.6 million adults over 18 years old are estimated to have used meth in the past year; compared to the 11 million people who used non-prescription opioids (including heroin) in 2017, this number is small. On the other hand, the number of adults who are estimated to use methamphetamine in their lifetime is over 14 million.
Based on NSDUH data, approximately 52.9% of methamphetamine users meet criteria for a methamphetamine use disorder. Unfortunately, fewer than 1/3 of adults with methamphetamine use disorder received treatment in the past year. This abysmal statistic can, in-part, be attributed to the treatment desert that exists for methamphetamine use disorder. There are currently no FDA-approved pharmacotherapies to treat methamphetamine use disorder, although the medications bupropion and naltrexone are used off-label. Until recently, the best option for treatment has been contingency management, a form of behavioral therapy that reimburses people who use drugs with cash or cash incentives as a form of positive reinforcement if they can provide biological proof of abstinence.
The tides may be turning, however, as a hallmark study in the field of methamphetamine treatment and addiction medicine was published in March 2020 by the Center on Substance Use and Health’s very own Phillip Coffin, MD, et al. In a placebo-controlled randomized controlled trial, mirtazapine 30 mg daily was found to have a modest yet significant effect in reducing positive results of methamphetamine urine testing and some HIV risk behaviors (e.g. number of male partners) among cisgender men and transgender women who have sex with men. This study finally gives clinicians and people who use methamphetamine an evidence-based pharmacologic option to try on for size, even taking into account the suboptimal medication adherence and retention in care that was reported among study participants.
In the NSDUH data, population rates of methamphetamine use were shown to be more-or-less stable compared to previous data, although both methamphetamine-related harms and product availability have increased. Comorbid mental illness and use of multiple substances, including binge drinking, were also common; among persons who used methamphetamine, an estimated 57.7% reported any mental illness. The highest estimated rates of lifetime use were among adults under 50 and among non-Hispanic whites, though Hispanics also have high rates. Interestingly, neither the study nor the NSDUH data included homeless or incarcerated populations, where methamphetamine use may be more prevalent. Creative study designs are needed to include this population in population estimates.
Rather than sensationalizing an illicit drug like methamphetamine, it’s best to stick to the facts to determine how to move forward. As we learned during the “crack epidemic,” sensationalizing drugs can cause political ramifications (e.g., mandatory minimums for drug sentencing) that can do more harm than good. The phenomena of methamphetamine use, homelessness, and mental illness intersect in elusive and poorly understood ways. Regardless, the emergence of effective medications to treat methamphetamine use disorder is critical to provide treatment options for those who want to reduce their meth use.
To hear firsthand stories about the impact of methamphetamine on men who have sex with men in New York City, check out the film, Crystal City: https://www.crystalcitymovie.com/.