Meth deaths have been increasing, and became the most common drug involved in drug overdoses in LAC
Although national attention on the drug overdose epidemic has been focused on opioids, methamphetamines are increasingly associated with a significant proportion of the drug overdose deaths.
From 2012-2018, the rate of drug overdose deaths in the US involving psychostimulants such as methamphetamine increased nearly 5-fold (Hedegaard, 2020).
From 2008-2018, there were 3,474 methamphetamine-involved deaths identified from death certificates in LAC. The number of deaths involving methamphetamine escalated from 125 to 661 deaths over the period. The age-adjusted rate of death per 100,000 population increased considerably by 417% from 1.2 to 6.2 (Figure 1).
Note: Methamphetamine-involved deaths in LAC were identified using the International Classification of Disease, Tenth Revision (ICD-10) codes for methamphetamine-related conditions (F15: abuse, dependence, use; T43.6: poisoning) in the underlying or multiple cause of death entries on the death certificate. ICD-10 codes for all other methamphetamine-related conditions (F15.0, F15.3-F15.8) had zero cases for all of the mentioned years. Rates adjusted for age to the 2000 US standard population.
Meth as Cause of Death
In LAC from 2008-2018, methamphetamine poisoning (n=2,734, 79%) was the most likely cause of death listed on death certificates compared to other methamphetamine-related conditions, followed by unspecified or uncomplicated methamphetamine use (n=1,038, 30%), and methamphetamine abuse (n=83, 2.4%). Dependence was rarely listed as a cause of death (not shown due to small numbers) (Figures 2-3).
Note: Each decedent could have more than one methamphetamine-related condition listed on their death certificate
Meth Detected at Death
According to LAC's Medical Examiner/Coroner's Office, methamphetamine was detected in over 5,000 decedents during 2013-2018. Detection of methamphetamine greatly increased from 696 cases in 2013 to 837 cases in 2017, and increased 35% to over one-third (38.4%) of drug-detected deaths from 2017-2018 (Figures 4-5). Since 2015, methamphetamine was the most commonly detected drug, surpassing narcotic analgesics.
Although detection of a drug does not necessarily implicate it as a cause of death, it provides important information on substance use behaviors and drug supply.
Meth Overdose Deaths
All drug deaths were identified using ICD-10 codes for drug overdoses of all intents as the underlying cause of death.
Opioid deaths exclude heroin.
In 2018, methamphetamine surpassed opioids as the most common drug involved in drug overdoses in LAC, accounting for 44% of all drug overdose deaths occurring in that year (Figure 6).
Overall there were a total of 1,989 deaths involving methamphetamine overdose in LAC from 2008-2018, comprising 57% of all methamphetamine-involved overdose deaths.
The number of methamphetamine-related deaths increased 912% from 43 in 2008 to 435 in 2018 (Figure 7).
Methamphetamine overdose-involved deaths were identified using ICD-10 codes for both the drug overdose of all intents as the underlying cause of death, and stimulant poisoning codes in the multiple cause of death entries on the death certificate. Rates adjusted for age to the 2000 US standard population.
In 2008-2018, males accounted for 78% of all methamphetamine overdose deaths in LAC. The annual number of deaths among males consistently increased from 25 to 331 deaths from 2008-2018. The age-adjusted rate per 100,000 population among males increased from 0.5 to 6.3 from 2008-2018 (Figures 8-9).
Methamphetamine overdose deaths occurred most frequently among those aged 0-34 years (n=553) and 45-54 years (n=560) during 2008-2018 (Figure 10). These two age groups had the greatest number of deaths annually from 2010-2018.
All age groups had high rates and rapid increases in death rates over the period. Specifically, those aged 45-54 years had the highest rate of death in 2018 (r=8.9), followed by those aged 35-44 years (r=7.7), whereas fatal overdoses for those aged 18-34 years and 55+ each had equal rates of 4 deaths per 100,000 population (Figure 11).
From 2008-2018, whites accounted for nearly half (49%) of LAC overdose deaths involving methamphetamine, with Latinxs comprising 36%, blacks 10%, and API 5% (Figure 12). Throughout 2008-2018, there were consistently more whites with methamphetamine overdose deaths compared to Latinxs and blacks. From 2014-2018, the age-adjusted rate of death per 100,000 population had increased substantially for whites (2.6 to 6.1) and Latinxs (1.0 to 3.5). Although there were few methamphetamine overdose deaths that occurred among blacks prior to 2014, fatal methamphetamine overdoses among blacks became more prevalent and increased to 63 deaths in 2018 (Figure 13).
Co-involvement of Opioids
In recent years, methamphetamine-related deaths in the US increasingly co-involved opioids. particularly illicitly manufactured fentanyl (IMF). From 2016-2017, psychostimulant-related deaths that co-involved opioids increased 52%, while those that were independent of opioids increased 23% (Hoots 2019). In 2017, opioids were involved in 50% of psychostimulant overdoses (Karissa 2019, Gladden 2019).
In LAC, methamphetamine overdose deaths co-involving opioids increased gradually from 2009-2015, then increased sharply from 2015-2016, and has continued to rise through 2018 (Figure 14).
Although methamphetamine overdose deaths co-involving synthetic opioids accounted for the smallest proportion among the opioid types, co-involvement of synthetic opioids had the greatest increase between 2016-2018 at 480% from 10 to 58 deaths. Deaths co-involving heroin increased from 49 to 80 deaths (Figure 15).
CDC. Wide‐ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2018. Available from: http://wonder.cdc.gov
Gladden, R. M., O’Donnell, J., Mattson, C. L., & Seth, P. (2019). Changes in opioid-involved overdose deaths by opioid type and presence of benzodiazepines, cocaine, and methamphetamine—25 states, July–December 2017 to January–June 2018. Morbidity and Mortality Weekly Report, 68(34), 737.
Hedegaard H, Miniño AM, Warner M. Drug Overdose Deaths in the United States, 1999–2018. NCHS, National Vital Statistics System, Mortality. NCHS Data Brief No. 356. January 2020. https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf
Hoots, B., Vivolo‐Kantor, A., & Seth, P. (2020). The rise in non‐fatal and fatal overdoses involving stimulants with and without opioids in the United States. Addiction.
Kariisa, M., Scholl, L., Wilson, N., Seth, P., & Hoots, B. (2019). Drug overdose deaths involving cocaine and psychostimulants with abuse potential—United States, 2003–2017. Morbidity and mortality weekly report, 68(17), 388.
National Drug Early Warning System (NDEWS) Coordinating Center ., 2015-2019. Los Angeles County Sentinel Community Site (SCS) Drug Use Patterns and Trends, for year 2013 to 2018. Available at https://ndews.umd.edu/publications/los-angeles-county-sentinel-community-site-scs.