Epidemiology

Methamphetamine use represents an increasing public health problem worldwide, and there are concerns that it may become the next substance use crisis in the US.[6] During the period 2010-20 an upward trend has been observed worldwide; quantities of methamphetamine seized have increased fivefold, and quantities of amphetamine have quadrupled.[7] In 2020, global seizures were estimated at 375 tonnes, up 16%, for methamphetamine; and at 75 tonnes, down 5%, for amphetamine.[7] Seizure data suggest that the production and trafficking of methamphetamine is spreading into new areas of the globe, and that there is now a small, but steadily growing, methamphetamine market in the European Union.[8][9]

In the US, a decline in methamphetamine exposures was initially seen after the passage of the Combat Methamphetamine Epidemic Act of 2005, but since 2007 the rate and severity of methamphetamine exposures have increased, driven by the use in people 20 years and older. The National Survey of Drug Use and Health reported that in 2021, 0.9% of the US population ages 12 and above had used methamphetamine in the past year, although caution is needed in interpretation of these data due to methodological differences in data collection owing to the Covid-19 pandemic. According to the same survey, 0.07% of the US population ages 12 and above had a methamphetamine use disorder in the past year; this risk was highest among adults ages 26 and over.[10][11]​​​ In 2022 in the US, an estimated 0.2% of 8th-graders, 0.3% of 10th-graders, and 0.5% of 12th-graders reported using methamphetamine in the past 12 months.[12]

Morbidity and mortality related to amphetamine and methamphetamine use are increasing. In the US, between 2012 and 2021, deaths involving methamphetamine, amphetamine, and prescription stimulants increased by more than 12-fold, from 0.8 per 100,000 in 2012 to 10.0 in 2021.[13] In 2020 in the US, approximately 23,837 people died from an overdose involving psychostimulants with abuse potential other than cocaine (primarily methamphetamine).[14] US deaths involving methamphetamine more than tripled between 2011 and 2016.[15] Between 2008 and 2015, hospitalizations related to amphetamine use more than tripled in the US.[16] In some states, deaths attributed to (meth)amphetamine toxicity now outnumber those attributed to opioid overdose.[17] An increase in overdose deaths may be partly explained by increases in potency and rises in polydrug use; over 50% of all stimulant-related deaths in the US also involve opioids.[13][18]​​ The emergence and increasing use of novel drugs in some locations, for example, cathinones and novel amphetamines, further complicates the epidemiology, as well as the risk profile, for people who use these substances.[19]

A number of local US studies have reported riskier patterns of methamphetamine use, such as injection with fentanyl (a synthetic opioid analgesic) or with heroin.[20][21][22]​​​​​​​​​​ Co-use of stimulants with fentanyl may be unintentional, given that in areas such as the US, much of the methamphetamines sold on the streets contain unpredictable levels of fentanyl, a fact of which people who use these drugs are often unaware.[23] American Indians and Alaska Natives have a particularly high risk for death from methamphetamine overdose.[24]

According to one large US data set (from 2010 tp 2019), smoking methamphetamine is the most common exposure route (68%), followed by intravenous use (24%) and sniffing/snorting (10%).[25] Comparing years 2000 to 2019, the odds of injecting methamphetamine were highest among black people in urban areas (odds ratio [OR] = 2.30, 95% confidence interval [CI] = 1.76 to 3.00, P <0.0001).[25]

One 2022 report estimates that in young adults in Europe between the ages of 15 and 34, 1.4 million used amphetamine or methamphetamine during the last year (1.4% of this age group).[7]​ Sniffing/snorting is the most common route of administration overall across Europe for both amphetamine and methamphetamine (67% and 41%, respectively). Injection is less common for amphetamine use overall (7%) but is reported as a common route of administration in some European countries, such as Finland, Norway, Poland, and Sweden. Injection is a more common route for methamphetamine use (31%).[26]

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