OXFORD, Miss. – Methamphetamine deaths in the U.S. rose 61-fold from 1999 to 2021, according to a new study, highlighting a growing crisis in addiction and public health.
Looking at the gender breakdown of these deaths could improve harm-reduction efforts and outcomes for patients suffering from addiction, said Andrew Yockey, University of Mississippi assistant professor of public health and co-author of the study.
"We know that, across the board, men are more likely to use every substance except tranquilizers than women, and we found that to be true here," Yockey said. "Especially if we're thinking about methamphetamine, we know that women have better treatment outcomes, and we know men are less likely to seek treatment.
"So, if we really start to design interventions with this in mind, we know we'll improve these outcomes."
Yockey and Rachel Hoopsick, assistant professor of health and kinesiology at the University of Illinois at Urbana-Champaign , published the team's findings on gender differences amongst methamphetamine deaths in the American Journal of Preventive Medicine . Their goal is to influence policy and highlight the ongoing crisis of methamphetamine-related fatalities in the United States.
"There were exponential increases in methamphetamine mortality among all people ages 15 to 74 in the U.S., both male and female," Hoopsick said. "However, the data from our study are suggesting that the sex-based differences in methamphetamine mortality may be narrowing.
"Not narrowing because we're seeing decreases in mortality in men, but because we're seeing accelerating mortality among women."
Although men have higher overall rates of mortality related to methamphetamine, the number of female deaths has been consistently increasing. Between 1999 and 2021, the rate of male deaths involving methamphetamine rose by a factor of 58.8. Female deaths rose by a factor of 65.3, narrowing the gap in total deaths-per year that involved the substance.
The sharpest rise came in between 2019-21, partly due to the COVID-19 pandemic , but also because of the rise of synthetic opioids and their prevalence among methamphetamine users, Yockey said.
Synthetic opioids – such as fentanyl, carfentanil and xylazine – are easier to make or acquire. When paired with methamphetamine, the substances are particularly deadly. The rate of deaths among men that co-involved methamphetamine and heroin or synthetic opioids rose from 13.1% to 61.5% in years the researchers studied.
"Opioid use appears to have abated in recent years, but what we're actually seeing is the rise of synthetic opioids," he said. "We're starting to see basic substances like methamphetamine being adulterated with synthetic opioids.
"When we're seeing overdoses and poisonings, the vast majority of them involve more than one of these substances."
The Mississippi Department of Health reported an increase of 182% percent in drug overdose deaths between 2011 and 2021. In the same period, the number of deaths involving synthetic opioids rose from 16 to 474, a nearly 30-fold increase.
This sharp increase over two decades, the difference in substance between men and women and the co-involvement of other substances highlight the need for more harm reduction efforts, the researchers said.
"Harm reduction is something we in the states talk about but don't put into practice very well," Yockey said. "Needle exchange programs, clean needles, supervised environments – these are for people who want to use drugs but do so safely. What I would love to see is more efforts like that in Mississippi."
Harm reduction efforts have greatly reduced both death and transmission of bloodborne diseases like HIV in Europe but have not been widely accepted or implemented in the United States .
"A better understanding of sex-based differences in substance use behaviors and motivations for using can help us to tailor more effective intervention and prevention strategies," Hoopsick said. "This might pave the way for U.S. policymakers prioritize a harm-reduction approach over what we have now, which really tends to prioritize a more punitive approach that leverages harsh criminal punishment for substance use."
Unlike other harmful substances, there is no FDA-approved medication that can aid in the withdrawal from stimulants like methamphetamine, Hoopsick said. This lack of aid for people who use methamphetamine only strengthens the researchers' belief in the necessity of harm reduction efforts.
"There are really effective medications that people can take to manage alcohol use disorder or opioid use disorder that help to reduce cravings, and those are incredible tools to leverage, but we don't have anything comparable to help with cravings from stimulants," she said. "So, it's not as easy as just saying, 'Put them on this medication and they'll be fine.'
"With harm reduction, it's about meeting people where they are and not leaving them behind."
Yockey, Hoopsick and Hannah Allen, executive director of William Magee Institute for Student Wellbeing and assistant professor of public health, will next study the relationship between methamphetamine use and suicide in 10 rural Mississippi counties.
The team will work with advocacy groups and community partners in those regions to assess their needs and provide resources where possible, Yockey said.
"This will allow us to do a couple of things. One is, of course, to get quantitative and qualitative data, but it also allows us to partner with narcotics bureaus, community partners and academic medical centers," he said. "Really our aim is to reduce meth use and to improve treatment for those at risk of suicide in Mississippi."
