Rates, characteristics and circumstances of methamphetamine-related death in Australia: a national 7-year study.
TL;DR: While toxicity was the most frequent cause, natural disease, suicide and accident comprised more than half of deaths, and methamphetamine death rates doubled in Australia from 2009 to 2015.
Abstract: Aims
To (1) assess trends in the number and mortality rates of methamphetamine-related death in Australia, 2009–15; (2) assess the characteristics and the cause, manner and circumstances of death; and (3) assess the blood methamphetamine concentrations and the presence of other drugs in methamphetamine-related death.
Design
Analysis of cases of methamphetamine-related death retrieved from the National Coronial Information System (NCIS).
Setting
Australia.
Cases
All cases in which methamphetamine was coded in the NCIS database as a mechanism contributing to death (n = 1649).
Measurements
Information was collected on cause and manner of death, demographics, location, circumstances of death and toxicology.
Findings
The mean age of cases was 36.9 years, and 78.4% were male. The crude mortality rate was 1.03 per 100 000. The rate increased significantly over time (P < 0.001), and at 2015 the mortality rate was 1.8 [confidence interval (CI) = 1.2–2.4] times that of 2009. Deaths were due to accidental drug toxicity (43.2%), natural disease (22.3%), suicide (18.2%), other accident (14.9%) and homicide (1.5%). In 40.8% of cases, death occurred outside the major capital cities. The median blood methamphetamine concentration was 0.17 mg/l, and cases in which only methamphetamine was detected had higher concentrations than other cases (0.30 versus 0.15 mg/l, P < 0.001). The median blood methamphetamine concentration varied within a narrow range (0.15–0.20 mg/l) across manner of death. In the majority (82.8%) of cases, substances other than methamphetamine were detected, most frequently opioids (43.1%) and hypnosedatives (38.0%).
Conclusions
Methamphetamine death rates doubled in Australia from 2009 to 2015. While toxicity was the most frequent cause, natural disease, suicide and accident comprised more than half of deaths.
Citations
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TL;DR: The current literature on methamphetamine-induced changes in cardiovascular health is examined, the potential mechanisms regulating these varied effects are discussed, and deficiencies in understanding how to treat methamphetamine-associated cardiovascular dysfunction are highlighted.
Abstract: While the opioid epidemic has garnered significant attention, the use of methamphetamines is growing worldwide independent of wealth or region. Following overdose and accidents, the leading cause of death in methamphetamine users is cardiovascular disease, because of significant effects of methamphetamine on vasoconstriction, pulmonary hypertension, atherosclerotic plaque formation, cardiac arrhythmias, and cardiomyopathy. In this review, we examine the current literature on methamphetamine-induced changes in cardiovascular health, discuss the potential mechanisms regulating these varied effects, and highlight our deficiencies in understanding how to treat methamphetamine-associated cardiovascular dysfunction.
124 citations
TL;DR: Methamphetamine use among heroin treatment admissions in the United States increased from 1 in 50 primary heroin treatment admitted in 2008 to 1 in 12 admissions in 2017, a relative percentage increase of 490% and an annual percent change (APC) of 23.4% (p<0.001).
Abstract: BACKGROUND AND AIMS Due to their small sample sizes, geographic specificity and limited examination of socio-demographic characteristics, recent studies of methamphetamine use among people using heroin in the United States are limited in their ability to identify national and regional trends and to characterize populations at risk for using heroin and methamphetamine. This study aimed to examine trends and correlates of methamphetamine use among heroin treatment admissions in the United States. DESIGN Longitudinal analysis of data from the 2008 to 2017 Treatment Episode Data Set. Descriptive statistics, trend analyses and multivariable logistic regression were used to examine characteristics associated with methamphetamine use among heroin treatment admissions. SETTING United States. PARTICIPANTS Treatment admissions of people aged ≥ 12 years whose primary substance of use is heroin. MEASUREMENTS Primary measurement was heroin treatment admissions involving methamphetamine. Secondary measurements were demographics of sex, age, race/ethnicity, US census region, living arrangement and employment status. FINDINGS The percentage of primary heroin treatment admissions reporting methamphetamine use increased each year from 2.1% in 2008 to 12.4% in 2017, a relative percentage increase of 490% and an annual percentage change (APC) of 23.4% (P < 0.001). During the study period, increases were seen among males and females and among all demographic and geographic groups examined. Among primary heroin treatment admissions reporting methamphetamine use in 2017, 47.1% reported injecting, 46.0% reported smoking, 5.1% reporting snorting and 1.8% reported oral/other as their usual route of methamphetamine use. CONCLUSIONS Methamphetamine use among heroin treatment admissions in the United States increased from one in 50 primary heroin treatment admissions in 2008 to one in 8 admissions in 2017.
100 citations
TL;DR: There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder, but psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence tosupport or discount their use.
Abstract: Aims Stimulant use disorder contributes to a substantial worldwide burden of disease, although evidence-based treatment options are limited This systematic review of reviews aims to: (i) synthesize the available evidence on both psychosocial and pharmacological interventions for the treatment of stimulant use disorder; (ii) identify the most effective therapies to guide clinical practice, and (iii) highlight gaps for future study Methods A systematic database search was conducted to identify systematic reviews and meta-analyses Eligible studies were those that followed standard systematic review methodology and assessed randomized controlled trials focused on the efficacy of interventions for stimulant use disorder Articles were critically appraised using an assessment tool adapted from Palmeteer et al and categorized for quality as ‘core’ or ‘supplementary’ reviews Evidence from the included reviews were further synthesized according to pharmacological or non-pharmacological management themes Results Of 476 identified records, 29 systematic reviews examining eleven intervention modalities were included The interventions identified include: contingency management, cognitive behavioural therapy, acupuncture, antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine, and psychostimulants There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder Psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence to support or discount their use Results of this review do not support the use of all other treatment options Conclusions The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder Although evidence to date is insufficient to support the clinical use of psychostimulants, our results demonstrate potential for future research in this area Given the urgent need for effective pharmacological treatments for stimulant use disorder, high-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed
91 citations
TL;DR: Overall, alcohol was the most harmful drug when harm to users and harm to others was combined, followed by cigarettes, crystal methamphetamine, cannabis, heroin and pharmaceutical opioids.
Abstract: Background/Aim:The aim of the current study was to review drug harms as they occur in Australia using the Multi-criteria Decision Analysis (MCDA) methodology adopted in earlier studies in other jur...
83 citations
Cites background from "Rates, characteristics and circumst..."
...Methamphetamine death rates have doubled in Australia from 2009 to 2015, with direct toxicity being the most frequent cause but acceleration of natural disease, suicide and accidental death also feature highly (Darke et al., 2017)....
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TL;DR: On the basis of low to moderate strength evidence, most medications evaluated for methamphetamine/amphetamine use disorder have not shown a statistically significant benefit, however, there is low strength evidence that methylphenidate may reduce use.
Abstract: Aims Addiction to methamphetamine/amphetamine (MA/A) is a major public health problem. Currently there are no pharmacotherapies for MA/A use disorder that have been approved for use by the US Food and Drug Administration or the European Medicines Agency. We reviewed the effectiveness of pharmacotherapy for MA/A use disorder to assess the quality, publication bias and overall strength of the evidence. Methods Systematic review and meta-analysis. We searched multiple data sources (MEDLINE, PsycINFO and Cochrane Library) to April 2019 for systematic reviews (SRs) and randomized controlled trials (RCTs). Included studies recruited adults who had MA/A use disorder; sample sizes ranged from 19 to 229 participants. Outcomes of interest were abstinence, defined as 3 or more consecutive weeks with negative urine drug screens (UDS); overall use, analyzed as the proportion of MA/A negative UDS specimens; and treatment retention. One SR of pharmacotherapies for MA/A use disorder and 17 additional RCTs met our inclusion criteria encompassing 17 different drugs (antidepressants, antipsychotics, psychostimulants, anticonvulsants and opioid antagonists). We combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses. We assessed quality, publication bias and the strength of evidence for each outcome using standardized criteria. Results There was low-strength evidence from two RCTs that methylphenidate may reduce MA/A use: 6.5 versus 2.8% MA/A-negative UDS in one study (n = 34, P = 0.008) and 23 versus 16% in another study (n = 54, P = 0.047). Antidepressants as a class had no statistically significant effect on abstinence or retention on the basis of moderate strength evidence. Studies of anticonvulsants, antipsychotics (aripiprazole), opioid antagonists (naltrexone), varenicline and atomoxetine provided either low-strength or insufficient evidence of no effect on the outcomes of interest. Many of the studies had high or unclear risk of bias. Conclusions On the basis of low- to moderate-strength evidence, most medications evaluated for methamphetamine/amphetamine use disorder have not shown a statistically significant benefit. However, there is low-strength evidence that methylphenidate may reduce use.
74 citations
References
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Journal Article•
TL;DR: Copyright (©) 1999–2012 R Foundation for Statistical Computing; permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and permission notice are preserved on all copies.
Abstract: Copyright (©) 1999–2012 R Foundation for Statistical Computing. Permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and this permission notice are preserved on all copies. Permission is granted to copy and distribute modified versions of this manual under the conditions for verbatim copying, provided that the entire resulting derived work is distributed under the terms of a permission notice identical to this one. Permission is granted to copy and distribute translations of this manual into another language, under the above conditions for modified versions, except that this permission notice may be stated in a translation approved by the R Core Team.
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01 Jan 2003
11,232 citations
"Rates, characteristics and circumst..." refers background in this paper
...6 million disability‐adjusted life years lost in 2010 attributable to amphetamine class dependence [3]....
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...It is estimated that there are some 35 million stimulant users world‐wide, predominantly of methamphetamine, and there have been large increases in production, seizures and use in recent years [3]....
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TL;DR: The regional and global distribution of use and estimated health burden from illicit drugs is outlined, and the health-related harms of cannabis use differ from those of amphetamine, cocaine, and opioid use, in that cannabis contributes little to mortality.
1,083 citations
TL;DR: Efficient strategies to reduce disease burden of opioid dependence and injecting drug use, such as delivery of opioid substitution treatment and needle and syringe programmes, are needed to reduce this burden at a population scale.
697 citations
TL;DR: The current public image of methamphetamine does not portray adequately the extensive, and in many cases insidious, harms caused.
Abstract: Issues. The major physical and psychological health effects of methamphetamine use, and the factors associated with such harms. Approach. Comprehensive review. Key Findings. Physical harms reviewed...
589 citations
"Rates, characteristics and circumst..." refers background in this paper
...For example, the use of alcohol with methamphetamine increases heart rate and blood pressure beyond that seen for methamphetamine use alone [13,36]....
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...The hypertensive effect of methamphetamine places strain upon the cardiovascular system, and is a causal factor in the progressive and accelerated development of cardiac disease, coronary atherosclerosis and other vascular disease [13,15,17]....
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...Multiple drugs appear common, and may influence the toxicity of methamphetamine [7,9,13,27,35]....
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...From the limited data on fatalities, there does not appear to be a clear dose response, such as seen with drugs such as alcohol or the opioids, and very low doses may be lethal [7,9,13,27,35]....
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