The United States is in the midst of what has been called the “fourth wave of the opioid epidemic,” a crisis characterized by the co-use of opioids and psychostimulants and further accelerated by the COVID-19 pandemic. In Oklahoma, the stimulant fueling this fourth wave is methamphetamine. The co-use of methamphetamine and opioids (including fentanyl) has resulted in a significant increase in overdose deaths involving both substances.
The Oklahoma State Department of Health reports that methamphetamine was involved in nearly two-thirds of the state’s drug overdose deaths in 2020. Unintentional overdose deaths involving methamphetamine have increased by 354% since 2010, and methamphetamine use in Oklahoma is significantly higher than in the U.S. – and increasing.
According to the National Survey on Drug Use and Health, from 2019 to 2020, only 0.9% of the U.S. population 18 and older used methamphetamine. The usage rate of methamphetamine in Oklahoma, 1.6%, is nearly twice the national rate. From 2016 to 2020, the percentage of adults age 18 and older in Oklahoma who reported methamphetamine use increased by 45.5%. Methamphetamine use has increased more rapidly in Oklahoma than the national average since 2017.
Based on treatment data provided by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), the percentage of admissions to ODMHSAS-funded substance use treatment providers related to methamphetamine has also increased significantly. Statewide, treatment admissions for patients with meth as a top-three drug of choice have increased by 70% since 2012, and treatment admission for methamphetamine as the primary drug of choice has increased by 88% since 2012.
According to the CDC, Oklahoma has a rate of 13 unintentional deaths per 100,000 people by psychostimulants with abuse potential, including methamphetamine; this is higher than the U.S. rate of 9 per 100,000. Furthermore, data from the Oklahoma State Department of Health shows the rate of unintentional methamphetamine overdoses per 100,000 people in Oklahoma has increased by 354% during the past 10 years.
Nationally, the fourth wave of the opioid epidemic is linked to an alarming increase in the co-use of psychostimulants, namely methamphetamine, among those who use opioids such as heroin or fentanyl. Methamphetamine potency is high, often lower cost, and more available than some opioids. Exposure to opioid contamination of the methamphetamine supply greatly increases overdose risk.
People who use drugs have reported co-use of methamphetamine as a means to subdue the symptoms of opioid withdrawal, reduce their opioid use by switching or substituting, or keep them safer from the consequences of an opioid overdose. The increase in the co-use of opioids and psychostimulants puts people at risk for higher rates of injection drug use (and therefore intravenous disease), serious mental illness, visits to the emergency room, days in the hospital, and contact with the criminal justice system.
Limited available treatments for methamphetamine use and overdose pose challenges to communities. The FDA has approved several medications for the treatment of alcohol and opioid use disorders that reduce craving and withdrawal, but there is currently no approved medication-assisted treatment for methamphetamine use disorder. A medication called naloxone can be administered to reverse the effects of opioid overdose if administered in time, but no such medication exists for methamphetamine overdose. Furthermore, many rural communities lack adequate access to behavioral health resources, including specialized professionals and transportation options for treatment.
Although the data appear daunting, Oklahoma is well-positioned to tackle this new wave of drug overdoses. Healthy Minds’ recent editorial in The Oklahoman noted that Oklahoma was a national leader in reducing prescription opioid overdoses, and the state can build off of the same collaborative approaches used to make headway on that crisis. The solutions will involve a comprehensive strategy that includes preventive services, medical and community-based treatment, and policy and regulatory interventions: