Meth use is driving overdose epidemic in rural America -- not opioids

Meth use is driving overdose epidemic in rural America — not opioids

PORTLAND — Hit shows like “Breaking Bad” put a spotlight on the dangerous nature of making and using methamphetamine. Now, a new study finds the common drug in pop culture is also a common problem in rural America. Researchers from Oregon Health & Science University say that meth use is actually driving the nation’s overdose crisis, rather than the commonly suspected cause — opioids.

In a study of more than 3,000 people living in rural communities, the team found that roughly four in five people who use drugs used methamphetamines within the last month.

“Among people who use drugs in rural communities, methamphetamine use is pervasive,” says Todd Korthuis, M.D., M.P.H., professor of medicine in the OHSU School of Medicine, in a university release. “This has been a West Coast problem for a long time, but now we see methamphetamine use in rural communities across the United States.”

The team focused on residents in 10 states between January 2018 and March 2020. These individuals lived in rural areas with the highest overdose rates in Oregon, Illinois, Kentucky, North Carolina, Ohio, Wisconsin, West Virginia, Massachusetts, New Hampshire, and Vermont.

What’s the difference between meth and opioids?

Methamphetamine, commonly referred to as meth or crystal meth, is a stimulant that induces a “high” that can sometimes last for over 12 hours. Opioids, like heroin, fentanyl, or prescription painkillers, are depressants that slow the activity of the central nervous system — including breathing. A high due to opioids is typically shorter than a meth high.

Much of the country’s attention has focused on opioids, since they account for the majority of over 100,000 overdose deaths in the U.S. last year, according to the researchers. Most of these deaths were the result of taking fentanyl — a synthetic opioid 50 to 100 times stronger than morphine.

However, Korthuis says this is causing many to overlook the problem of widespread methamphetamine use outside of the urban cities. Moreover, the study authors note that fentanyl is now frequently contaminating batches of methamphetamine. While people may think they’re only taking a stimulant, they’re actually receiving a potentially fatal dose of opioids.

Results of the Rural Opioid Initiative study show that people taking both methamphetamine and opioids had the highest risk of suffering a non-fatal overdose. More than one in five (22%) taking both substances reported suffering an overdose within the previous six months.

Among rural Americans saying they only use opioids, 14 percent experienced a recent overdose. Meanwhile, just six percent of those only using meth suffered a non-lethal overdose.

“Co-use of methamphetamine and opioids is associated with a big increased risk of overdose in rural communities,” Korthuis says. “Some people view rural areas as immune to problems like drug use and overdose, but they’re not.”

Economic distress in rural America bringing on more ‘deaths of despair’

The study also found that economic distress is a widespread problem among these communities where drugs are prevalent. In fact, 53 percent reported being homeless at some point over the previous six months. Researchers say these issues among low-income communities increase the number of “deaths of despair” — those involving overdoses, suicide, and diseases linked to drugs and alcohol.

“There are deaths of despair everywhere, but our rural communities have been hard hit,” Korthuis explains.

The study authors add that treatment problems are least likely to reach Americans living in these communities. Four in 10 respondents said they tried to get treatment for substance abuse but were unable to find help in their area. Among those using both meth and opioids, 44 percent could not access treatment.

The team also warns that people taking meth rarely receive naloxone, an overdose treatment that often revives people taking fentanyl. They urge health officials to expand the distribution of this overdose drug so people who take methamphetamine have it as well.

The study is published in JAMA Network Open.

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