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 837 cases in 2017, and increased 35% to over half (53.5%) of drug-detected deaths from 2017-2019 (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 2008-2019, there were 4,299 methamphetamine-involved deaths identified from death certificates in LAC. The number of deaths involving methamphetamine escalated from 125 to 825 deaths over the period. The age-adjusted rate of death per 100,000 population increased considerably by 550% from 1.2 to 7.8 (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; 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 2008-2019, methamphetamine poisoning (n=3,446, 81.5%) was the most cause of death listed on death certificates compared to other methamphetamine-related causes of death such as methamphetamine use  and methamphetamine abuse. Methamphetamine poisoning was followed by unspecified or uncomplicated methamphetamine use (n=1,191, 28.2%), and methamphetamine abuse (n=95, 2.3%). 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

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.

According to death certificate data, in 2019, methamphetamine and opioids are the most common drugs involved in drug overdoses in LAC.

Methamphetamine accounted for 45% of all drug overdose deaths in 2019  (Figure 6a).

According to the LAC Coroner's data, there were more methamphetamine overdose deaths than that reported on death certificates.. There were 1,389 methamphetamine-related deaths in 2020 which has increased 68% from 2019 (822 deaths) (Figure 6b

According to LAC Coroner's data, in 2020, the methamphetamine overdose age-adjusted death rate was 12.8, compared to 10.7 for fentanyl and 14.1 for all opioids per 100,000 population (Figure 7).


Figure 7. Methamphetamine overdose age-adjusted death rate per 100,000 population, LAC, 2010-2020

Source: LAC Coroner

Demographics

Gender

In 2008-2019, males accounted for 78% of all methamphetamine overdose deaths in LAC. The annual number of deaths among males consistently increased from 25 to 442 deaths from 2008-2019. The age-adjusted rate per 100,000 population among males increased from 0.5 to 8.9 from 2008-2019 (Figures 8-9).

Age

Methamphetamine overdose deaths occurred most frequently among those aged 0-34 years (n=702) and 45-54 years (n=716) during 2008-2019 (Figure 10). These two age groups had the greatest total number of deaths from 2010-2019. 

All age groups had high rates and rapid increases in death rates over the period. Specifically, those aged 45-54 years had the highest number of death and rate of death in 2019 (r=11.8), followed by those aged 35-44 years (r=8.5), whereas fatal overdoses for those aged 18-34 years and 55+ each had similar rates of 5.8 deaths and 5.9 deaths per 100,000 population respectively (Figure 11).

Race/Ethnicity

From 2008-2019, whites accounted for 43% of LAC overdose deaths involving methamphetamine, with Latinxs comprising 33%, blacks 19%, and API 4% (Figure 12). Throughout 2008-2019, there were consistently more whites with methamphetamine overdose deaths compared to Latinxs and blacks. From 2014-2019, the age-adjusted rate of death per 100,000 population had increased substantially for whites (2.6 to 8.3) and Latinxs (1.0 to 4.4). 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 80 deaths in 2019 (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 2019 (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 2016-2019 at 1150% from 10 to 125 deaths. Deaths co-involving heroin increased from 49 to 123 deaths (Figure 15).

References

CDC. Wide‐ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2019. 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.