Methamphetamine is driving an epidemic of drug overdoses in rural America, a new study concludes.
Researchers attribute the surge to meth laced with fentanyl or combined with an opioid that contains fentanyl.
"Methamphetamine is increasingly contaminated or adulterated with fentanyl, which is 50 to 100 times more potent than heroin," said lead researcher Dr. Todd Korthuis, director of the Addiction Medicine Section at Oregon Health & Science University, in Portland.
"People may think that they're smoking or injecting their usual methamphetamine supply and end up with an unintentional opioid overdose," Korthuis explained.
For the study, Korthuis and his colleagues surveyed more than 3,000 participants in the Rural Opioid Initiative study between January 2018 and March 2020. Participants were from rural areas in Illinois, Kentucky, Massachusetts, New Hampshire, North Carolina, Ohio, Oregon, West Virginia, Wisconsin and Vermont.
"Our rural communities have long been under economic stressors and social stressors that have left people susceptible," Korthuis said.
In all, 53% of survey respondents had been homeless in the previous six months. Economic despair is a major factor in overdose deaths, along with increases in alcoholism and suicides in rural America, Korthuis added.
The study found that 22% of people who used both meth and an opioid reported overdosing in the past six months. That compared to 14% who used only opioids and 6% who used meth only.
Although the drug naloxone can reverse a fentanyl overdose, it's rarely given to people using meth, Korthuis noted.
"Naloxone will not treat methamphetamine use, however, so much of the methamphetamine supply is now laced with fentanyl that if somebody has an overdose, they should always get naloxone, because chances are the drug you thought they were taking also has the potent opioid in it," he said.
A key barrier to stemming the tide of meth overdoses is the lack of treatment centers in rural areas. The study noted that 40% of participants who sought addiction treatment couldn't get it. The percentage was even higher (44%) among those who used both meth and opioids.
Korthuis pointed out that many providers who offer treatment for heroin use or pills turn away people if they're using meth.
"We need to educate our treatment community that treats opioid use disorder to also incorporate treatment for methamphetamine use disorder," he said.
Linda Richter, vice president for prevention research and analysis at the Partnership to End Addiction, lamented the findings.
"This study confirms that polysubstance use is prevalent among people who use drugs, and that our nation's tendency to tackle one drug problem at a time fails to take this reality into account, with disastrous consequences," Richter said.
Combining meth with opioids dampens the negative side effects of each, or it prolongs the intoxicating effect of opioids and staves off withdrawal, which is why some people prefer this mix, she explained. This combination, however, is highly dangerous. It impairs motor skills and increases the risk of stroke, heart attack, aneurysm and respiratory failure.
"The two types of drugs mask many of each other's effects. There is an increased risk of overdose, as the person is unable to gauge the extent to which each drug is having an adverse effect on the brain and body," Richter said. "Further, because the drugs' effects can last for different time periods, once one wears off, the effects of the other can kick in quickly, either rapidly accelerating heart and respiration rates and leading to arrhythmias, heart failure or stroke or respiratory failure."
Because most users can't detect if or when their drug is laced with fentanyl, Richter said, it's essential to make naloxone more available.
She said it is essential to invest in prevention and early intervention and to address all addictive substances, not just the latest drug trend.
"Prevention efforts that target the underlying social and structural determinants of drug use and addiction, including inadequate and unstable employment, housing, child care, health care and neighborhood safety, are the most likely to be successful," Richter said.
"We also must do more to expand the treatment workforce, by making addiction treatment part of mainstream health care and incentivizing qualified providers to serve rural communities and marginalized populations," she added.
Richter said medication-based addiction treatment must be made available to people with opioid addiction, and the stigma surrounding it must be reduced.
"To address the immediate overdose problem, we need to boost public awareness to inform people who use methamphetamine and opioids of the high risk that their drug can be laced with fentanyl, and offer them life-saving harm reduction tools, including fentanyl test strips and sterile needles," she said.
The new study was published online Aug. 15 in JAMA Network Open.
For more on methamphetamine, head to the U.S. National Institute on Drug Abuse.
SOURCES: Todd Korthuis, MD, MPH, professor, medicine, director, Addiction Medicine Section, Oregon Health & Science University, Portland; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction; JAMA Network Open, Aug. 15, 2022, online