United States military veterans are increasingly vulnerable to stimulant-involved deaths, according to new research. Many of the deaths were attributed to polysubstance use, underscoring the dangers facing people who are knowingly or unknowingly using drugs in combination.
The study, published in the journal Addiction, focused on military veterans because of the large, nationally representative database of medical data available from the Veterans Health Administration (as opposed to studying that population because of any specific risk factors).
The pandemic contributed to 2020 being the deadliest year on record for overdose in the US. Fentanyl-involved deaths (with or without other drugs) spiked last year, but deaths involving heroin and prescription opioids continued to decrease, as they have every year since 2014 (a death is counted in two categories if it involves more than one drug). During this time, cocaine- and methamphetamine-involved deaths (with or without other drugs) steadily increased each year.
Between 2012-2018, more than 3,600 veteran deaths in the US involved stimulants (alone or with other drugs). The most overall deaths among those studied—roughly one in three—were attributed to the combination of cocaine and opioids. That was followed by deaths involving cocaine alone, and then those involving methamphetamine alone.
“The adulteration of synthetic opioids in the stimulant supply is likely contributing,” study coauthor and University of Michigan psychiatry professor Lewei Allison Lin told Filter. “But the fact that almost half of those who died did not have additional substances [in their system] indicates there are likely multiple substance use patterns that need to be addressed, including use of stimulants alone.”
Overall, deaths involving stimulants (alone or with other drugs) tripled over the six-year period. The rate of deaths involving cocaine and opioids increased the most—more than quadrupling.
“There are likely multiple substance use patterns that need to be addressed, including use of stimulants alone.”
Cocaine (referring to both powder and crack) was overall involved in about two out of three (66.5 percent) deaths, while more than one in three (37.5 percent) involved methamphetamine. More than half (54 percent) of all deaths involving stimulants also involved another drug, with the overwhelming majority being opioids.
Opioid-involved deaths involved heroin (45 percent) and fentanyl (46 percent) at similar rates, while a smaller portion involved prescription opioids (26 percent). The study didn’t examine cases where people used more than one kind of opioid at the same time. In deaths involving stimulants and non-opioid drugs, the most common was other drug was alcohol (76 percent). A smaller proportion (19 percent) involved barbiturates or benzodiazepines.
“We need to think about tailoring our prevention/treatment strategies to these different populations and really think about how best to reach these different groups,” Lin said.
What the data do not show is any differentiation between deaths caused by polysubstance use where the substances were combined intentionally by the person consuming them, versus deaths caused by the unknown presence of, for example, fentanyl, in what someone had consumed believing it to be purely a stimulant.