For the first time since the 1990s, fatal drug overdoses decreased in 2018, according to preliminary Center for Disease Control and Prevention (CDC) data. But journalists and advocates alike caution against making definitive conclusions about the trajectory of the crisis—an estimated 66,000 deaths still occurred last year—until final numbers are available later this year. For Drug Policy Alliance (DPA) Executive Director Maria McFarland Sánchez-Moreno, the country still has “a long way to go” until a victory can be claimed.
The rising number of overdose deaths involving stimulants is one such area of concern. In particular, “psychostimulants with the potential for abuse,” a category that includes methamphetamine, are estimated by the CDC to be associated with nearly 13,000 deaths nationwide in 2018—the equivalent figure for 2017 stood at 10,000. The 2018 preliminary figure converges on, and slightly surpasses, the number for prescription opioid-involved overdose deaths.
“There are a lot of factors that contribute to a decrease in prescription opioid drug-involved deaths, namely that legislation has been passed throughout the country to limit people’s access to prescription opioids, which actually isn’t an evidence-based solution,” said Kristen Marshall, Harm Reduction Coalition’s program manager for the DOPE Project. “In fact, limiting people’s access to resources—in this case, opioids—means they will need to get their needs met some other way, and will switch to other opioids, like heroin.”
Georgia mirrors the national trend of dropping numbers of deaths involving prescription opioids and increasing numbers of those involving methamphetamine. In 2018, 392 and 390 people, respectively, died from overdoses involving meth and prescription opioids like oxycodone or morphine. In contrast to national trends, meth is the most common drug involved in overdose deaths in Georgia—even more so than synthetic opioids like fentanyl, which have been recognized by the CDC as driving the “third wave” of the crisis since 2013.
The increasing number of meth-involved overdose deaths could be, in part, attributed to fentanyl-adulterated supply. Illicit cocaine and meth seized by law enforcement on the street level “almost always” contain fentanyl, commented Jack Killorin, public safety director for the Overdose Response Strategy, a public health and public safety collaboration of the High Intensity Drug Trafficking Area Program.
Some Atlanta meth users are increasingly injecting the drug, versus sniffing or smoking it, which greatly increases harms and risks associated with its use. People admitted to the city’s public drug treatment programs who reported injection use of meth doubled between 2005 and 2017, leaping from 11 percent to 23 percent.
In 2015, 9 percent of Atlanta’s surveyed injection drug users—more than half of whom were black—reported they injected methamphetamine. Back in 2006 (the rate has likely changed since) 14 percent of men who have sex with men (MSM) and use meth reported that they have injected the stimulant, though it was considered the least preferable consumption route. In 2017, nearly a quarter of all individuals “seeking treatment in the city” were injection meth users.
Skeptics of the CDC’s data point out that overdose deaths do not fully capture the scope of the crisis. “People are dying of other causes before overdosing,” tweeted Keith Brown, the director of Health and Harm Reduction at the Katal Center. For example, people who are inject drugs face higher risks of HIV transmission and its related complications.
In the context of meth use, and especially among queer men, injecting the drug is often “accompanied” with unprotected anal sex. Meth can make the body more vulnerable to HIV transmission because of its drying effect on mucosa, which can lead to tearing and exposure. In 2007, 35 percent of current new HIV infections among Atlanta‘s MSM were linked to methamphetamine use.
In addition to the drug’s physiological harms, social forces threaten meth users’ lives. From 2012 to 2017, one in five of people killed by police in Atlanta tested positive for meth, reported the Seattle Times.
More broadly, Dr. Sheila Vakharia*, a drug policy researcher at DPA’s Office of Academic Engagement, notes that meth is often used by people who are homeless or unstably housed to stay awake and remain safe. “Meth use needs to be seen within broader social and economic factors,” she said.
As policy responses to the overdose crisis become an increasingly-popular talking point among politicians, Vakharia stresses that “the solutions to opioids don’t necessarily translate to stimulants. People want simple solutions, but it’s more complicated.”
Photograph of crystal methamphetamine by Radspunk via Wikimedia Commons
* Dr. Vakharia is also a board member of The Influence Foundation, which operates Filter.
