Deaths

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).

Meth Detected at Death

According to LAC's Medical Examiner/Coroner's Office, methamphetamine was detected in over 6,000 decedents during 2013-2019. Detection of methamphetamine greatly increased from 696 cases in 2013 to 1,285 cases in 2019, and increased from 22.4% to 40.3% of deaths that tested positive for drugs from 2013-2019 (Figures 1-2). 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-Involved Deaths

From 2008-2020, there were 5,653 methamphetamine-involved deaths identified from death certificates in LAC. The number of deaths involving methamphetamine escalated from 125 to 1,354 deaths over the period. The age-adjusted rate of death per 100,000 population increased considerably by 975% from 1.2 to 12.9 (Figure 3).

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 of other stimulants; T43.6: poisoning by psychostimulants with abuse potential) 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 Condition as Cause of Death

In LAC from 2008-2020, methamphetamine poisoning (n=4,633, 82%) was the most likely cause of death listed on death certificates compared to other methamphetamine-related causes of death, followed by unspecified or uncomplicated methamphetamine use (n=1,432, 25.3%), and methamphetamine abuse (n=119, 2.1%). Dependence was rarely listed as a cause of death (not shown due to small numbers) (Figures 4-5). 

Note: Each decedent could have more than one methamphetamine-related condition listed on their death certificate

Meth Overdose Deaths

Death Certificate Data

In 2020, methamphetamine and opioids were the most common drugs involved in drug overdose deaths in LAC.

Methamphetamine accounted for 52% of all drug overdoses in 2020  (Figure 6).

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.

Coroner Data

According to the LAC Coroner's data, there were more methamphetamine overdose deaths than that reported on death certificates. 

There were 1,526 methamphetamine-related deaths in 2021, a 6% increase from the previous year (Figure 7

According to LAC Coroner's data, in 2021, the methamphetamine overdose age-adjusted death rate was 14.2 compared to 14.3 for fentanyl and 16.3 for all opioids per 100,000 population (Figure 8).


Figure 8. Methamphetamine overdose age-adjusted death rate per 100,000 population, LAC, 2010-2021
Source: LAC Coroner

Demographics

Gender

In 2008-2020, males accounted for 78% of all methamphetamine overdose deaths in LAC. The annual number of deaths among males consistently increased from 25 to 809 deaths from 2008-2020. The age-adjusted rate per 100,000 population among males increased from 0.5 to 15.5 from 2008-2020 (Figures 9-10).

Age

Methamphetamine overdose deaths occurred most frequently among those aged 0-34 years (n=981) and 45-54 years (n=981) during 2008-2020 (Figure 11). These two age groups had the greatest total number of deaths from 2008-2020. 

All age groups had high rates and rapid increases in death rates over the period. Specifically, those aged 18-34 years had the highest number of deaths in 2020. Those aged 45-54 years had the highest rate of death in 2020 (r=20.4), followed by those aged 35-44 years (r=17.2), whereas fatal overdoses for those aged 18-34 years and 55+ each had similar rates of 10.8 deaths and 9.8 deaths per 100,000 population respectively (Figure 12).

Race/Ethnicity

From 2008-2022, whites accounted for 46% of LAC overdose deaths involving methamphetamine, while Latinxs comprised 36%, blacks 12%, and others 5% (Figure 13). Throughout 2008-2020, there were consistently more whites with methamphetamine overdose deaths compared to Latinxs and blacks. From 2014-2020, the age-adjusted rate of death per 100,000 population had increased substantially for whites (2.6 to 14.9) and Latinxs (1.0 to 7.8). 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 165 deaths by 2020 (Figure 14). 

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 and jump again in 2020 (Figure 15).

Co-involvement of synthetic opioids increased 3,940% between 2016-2020 from 10 to 404 deaths. Deaths co-involving heroin increased from 49 to 182 deaths (Figure 16).

References

CDC. Wide‐ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. 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, 2015-2020. Los Angeles County Sentinel Community Site (SCS) Drug Use Patterns and Trends, for year 2013 to 2019. Available at https://ndews.umd.edu/publications/los-angeles-county-sentinel-community-site-scs.