Methamphetamine use is driving an overdose epidemic in rural America – not opioids

PORTLAND— Hit shows like “Breaking Bad” shine a light on the dangerous nature of meth manufacturing and use. Now, a new study reveals that the drug common in pop culture is also a common problem in rural America. Researchers at Oregon Health and Science University say meth use is actually at the root of the nation’s overdose crisis, rather than the commonly suspected cause – opioids.

In a study of more than 3,000 people living in rural communities, the team found that about four in five people who use drugs had used methamphetamine in the past month.

“Among people who use drugs in rural communities, methamphetamine use is pervasive,” said Todd Korthuis, MD, MPH, professor of medicine at the OHSU School of Medicine, in a university statement. “It has long been a problem on the West Coast, but now we are seeing crystal meth use in rural communities across the United States.”

The team focused on residents of 10 states between January 2018 and March 2020. These people lived in rural areas with the highest overdose rates in Oregon, Illinois, Kentucky, Carolina North, Ohio, Wisconsin, West Virginia, Massachusetts, New Hampshire and Vermont. .

What is the difference between methamphetamine and opioids?

Methamphetamine, commonly known as meth or crystal meth, is a stimulant that causes a “high” that can sometimes last for over 12 hours. Opioids, such as heroin, fentanyl, or prescription painkillers, are depressants that slow central nervous system activity, including breathing. An opioid high is usually shorter than a methamphetamine high.

Much of the country’s attention has focused on opioids, as they accounted for the majority of the more than 100,000 overdose deaths in the United States last year, researchers say. Most of these deaths were due to taking fentanyl, a synthetic opioid 50 to 100 times more potent than morphine.

However, Korthuis says this causes many to overlook the problem of widespread meth use outside of urban towns. Additionally, the study authors note that fentanyl now frequently contaminates batches of methamphetamine. While people may think they’re just taking a stimulant, they’re actually getting a life-threatening dose of opioids.

Results from the Rural Opioid Initiative study show that people taking both methamphetamine and opioids had the highest risk of experiencing a non-fatal overdose. More than one in five (22%) taking both substances said they had overdosed in the previous six months.

Among rural Americans who report using only opioids, 14% have recently overdosed. Meanwhile, only 6% of those who only used methamphetamine experienced a non-fatal overdose.

“The co-use of methamphetamine and opioids is associated with an increased risk of overdose in rural communities,” Korthuis said. “Some people see rural areas as immune to issues like drug use and overdoses, but that’s not the case.”

Economic distress in rural America leading to more ‘deaths of despair’

The study also revealed that economic distress is a widespread problem in these communities where drugs are prevalent. In fact, 53% said they had been homeless at some point in the previous six months. Researchers say these problems in low-income communities increase the number of “deaths of despair” – those involving overdoses, suicides and drug and alcohol-related illnesses.

“There are deaths of despair everywhere, but our rural communities have been hit hard,” says Korthuis.

The study authors add that treatment problems are least likely to affect Americans living in these communities. Four in 10 respondents said they had tried to seek treatment for drug addiction, but could not find help in their area. Among those who used both methamphetamine and opioids, 44% did not have access to treatment.

The team also warns that people taking methamphetamine are rarely given naloxone, an overdose treatment that often revives people taking fentanyl. They are urging health officials to expand distribution of the overdose drug so that people who take meth also get it.

The study is published in Open JAMA Network.