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Increasing Morbidity and Mortality Associated with Abuse of Methamphetamine -- United States, 1991-1994

Methamphetamine (also known as "speed," "crystal," "crank," "go," and "ice") is the most widely illegally manufactured, distributed, and abused type of amphetamine, a class of stimulant drugs. An estimated 4 million persons in the United States have abused methamphetamine at least once (1). Information from several sources -- including medical examiners, hospital emergency departments (EDs), substance-abuse-treatment facilities, and community epidemiologists -- suggests a recent increase in morbidity and mortality associated with abuse of methamphetamine in the United States, primarily in the West but also in the South and Midwest. To characterize trends in methamphetamine-associated morbidity and mortality during 1991-1994, the Substance Abuse and Mental Health Services Administration (SAMHSA) compiled and analyzed data from the Drug Abuse Warning Network (DAWN) and the Treatment Episode Data Set (TEDS). This report summarizes the results of these analyses.

DAWN

DAWN comprises 1) data on drug-abuse-related deaths reported by medical examiners in participating metropolitan areas (42 in 1994) (2) and 2) data on drug-related episodes from a national probability sample of participating hospital EDs (496 in 1994) (3,4).

From 1991 to 1994, the number of methamphetamine-related deaths reported by medical examiners nearly tripled from 151 to 433 Table_1. The number of methamphetamine-related deaths increased by 850% in Phoenix, 238% in San Diego, 144% in San Francisco, and 113% in Los Angeles. In 1994, most of the 433 decedents were aged 26-44 years (284 {66%}), male (345 {80%}), and white (343 {80%}). Nearly all the deaths (398 {92%}) involved methamphetamine in combination with at least one other drug, most often alcohol (128 {30%}), heroin (98 {23%}), or cocaine (92 {21%}).

Methamphetamine-related ED episodes more than tripled from 4900 in 1991 to 17,400 in 1994; the largest percentage increases occurred in Phoenix, Denver, Minneapolis/St. Paul, and Seattle Table_2. In addition, methamphetamine-related ED episodes increased in cities in the South and Midwest, including Atlanta, St. Louis, and Dallas. The numbers of methamphetamine-related ED episodes increased 267% among males (from 3057 to 11,214) and 238% among females (from 1810 to 6123).

TEDS

TEDS comprises data about client admissions to specialty (primarily publicly funded) substance-abuse-treatment facilities (5).

For both 1992 and 1993, a total of 42 states and the District of Columbia reported data on the number of admissions for publicly funded substance-abuse treatment, for which methamphetamine was mentioned as the primary drug of abuse. In these states, the number of admissions increased 43%, from 13,886 in 1992 to 19,797 in 1993. Increases occurred in 23 of the 29 states with greater than or equal to 10 methamphetamine-related admissions in both years. Most (15,695 {80%}) reported admissions for treatment of primary methamphetamine abuse were from California, followed by Nevada (630), Hawaii (482), and Colorado and Washington (444 each). The percentage increases from 1992 to 1993 were greatest in Washington (179 to 444 {148%}), Utah (66 to 154 {133%}), Minnesota (102 to 232 {128%}), and Idaho (77 to 166 {116%}). In addition, among metropolitan areas, percentage increases were greatest in Minneapolis/St. Paul (62 to 152 {145%}), Los Angeles (655 to 1245 {90%}), Seattle (67 to 118 {76%}), and San Diego (1601 to 2253 {41%}). The primary reported routes of methamphetamine administration were "snorting" in Los Angeles and San Diego and injection in Denver, San Francisco, and Seattle.

Reported by: JC Greenblatt, MPH, JC Gfroerer, D Melnick, PhD, Office of Applied Studies, Substance Abuse and Mental Health Svcs Administration.

Editorial Note

Editorial Note: Methamphetamine is often abused with other drugs (e.g., alcohol, cocaine, or heroin) and can be "snorted," injected, or smoked. One mode of administration may dominate in a particular area (6). Methamphetamine abusers have reported physical symptoms that include weight loss, tachycardia, tachypnea, hyperthermia, insomnia, and muscle tremors. The behavioral and psychiatric symptoms reported most often include violent behavior, repetitive activity, memory loss, paranoia, auditory hallucinations, and confusion or fright (7).

The analyses in this report document recent dramatic increases in methamphetamine-related deaths, ED episodes, and persons seeking treatment for methamphetamine abuse. In comparison, during 1979-1982, cocaine-re 12,400), and by 1994, the number of episodes increased to 142,400. However, in some areas, methamphetamine is more popular than cocaine, possibly because of its increasing availability in many western cities, relatively inexpensive cost, more immediate and sustained effect than powdered cocaine or crack, and multiple routes of administration (i.e., injection, "snorting," ingestion, and smoking). In addition, unlike cocaine and marijuana, methamphetamine is relatively easily manufactured in large quantities from materials available in the United States or obtained from abroad.

The findings in this report are subject to at least three limitations. First, drug-abuse-related deaths included in DAWN are reported by medical examiner facilities in selected metropolitan areas and are not representative of all such deaths that occur in the United States. Second, only cases that resulted in death and subsequently were identified as drug-abuse-related by a medical examiner facility were reported. In addition, procedures used to identify drug-abuse-related deaths and their associated drugs may vary by facility. Third, TEDS included reports primarily from publicly funded treatment facilities, which account for approximately half of all admissions to substance-abuse treatment in the United States. Only 45 states participate in TEDS, and some participating states do not separately identify abusers of methamphetamine from those of other stimulants.

In addition to the direct adverse health effects of methamphetamine, other risks may be associated with abuse of this drug. For example, based on data for June 1990-March 1993 from 11 city and state health departments, 16% of 1147 drug injectors with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) reported amphetamine as the primary drug injected (8). The proportion of drug injectors with HIV infection or AIDS who reported amphetamines as their primary drug varied substantially by location and were highest at sites in the West (Washington, 56%; Denver, 31%; Arizona, 25%; and Los Angeles, 23%). In all regions of the United States, men having sex with men were substantially more likely than heterosexuals to report amphetamines as the primary drug they injected (8). These variations and the findings in this report indicate the importance of evaluating local drug-abuse patterns for planning prevention and treatment services.

SAMHSA reports are available to Internet users through ftp://ftp.samhsa.gov and http://www.samhsa.gov, and on the following bulletin boards: The University of Maryland's CESAR, CSAP's PREVLINE, and CompuServe's Public Health Forum. SAMHSA reports also may be obtained from the Office of Applied Studies, RM16C-06, 5600 Fishers Lane, Rockville, MD 20857; telephone (301) 443-7980.

References

  1. Substance Abuse and Mental Health Services Administration. National Household Survey on Drug Abuse: main findings, 1993. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, 1995; DHHS publication no. (SMA)95-3020.

  2. Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Annual medical examiner data, 1993: data from the Drug Abuse Warning Network. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, 1995:79; DHHS publication no. (SMA)95-3019. (Statistical series I, no. 13-B).

  3. Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Annual emergency room data, 1992: data from the Drug Abuse Warning Network. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, 1994:137; DHHS publication no. (SMA)94-2080. (Statistical series I, no. 12-A).

  4. Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Preliminary estimates from the Drug Abuse Warning Network: 1994 preliminary estimates of drug-related emergency department episodes. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, 1995. (Advance report no. 11).

  5. Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Client admissions to specialty substance abuse treatment in the United States: Treatment Episode Data Set (TEDS), fiscal year 1993. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration (in press).

  6. Community Epidemiology Work Group. Epidemiologic trends in drug abuse: volume I: highlights and executive summary. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse, June 1995; DHHS publication no. (NIH)95-3990.

  7. Miller MA. Trends and patterns of methamphetamine smoking in Hawaii. In: Miller MA, Kozel NJ, eds. Methamphetamine abuse: epidemiologic issues and implications. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse, 1991; DHHS publication no. (AM)91-1836. (Research monograph no. 115).

  8. Diaz T, Chu SY, Byers RH, et al. The types of drugs used by HIV-infected injection drug users in a mulitstate surveillance project: implications for intervention. Am J Public Health 1994; 84:1971-5.



Table_1
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TABLE 1. Number of deaths associated with methamphetamine abuse, * by year
-- selected U.S. metropolitan areas, 1991-1994
============================================================================
Metropolitan area   1991       1992        1993        1994        Total
----------------------------------------------------------------------------
Los Angeles           63         55         126         134          378
San Diego             34         71          77         115          297
San Francisco         27         31          54          66          178
Phoenix                8         16          37          76          137
Philadelphia          10         18          25          17           70
Dallas                 2          7           5           9           23
St. Louis              2          1           5           7           15
Other +                5          6           6           9           26

Total                151        205         335         433         1124
----------------------------------------------------------------------------
* Excludes deaths in which acquired immunodeficiency syndrome was reported,
  deaths in which "drug unknown" was the only substance mentioned, and
  homicides.
+ The following metropolitan areas each reported <=10 deaths during
  1991-1994: Atlanta; Baltimore; Buffalo; Chicago; Cleveland; Denver;
  Detroit; Indianapolis; Kansas City; Miami; Minneapolis; New Orleans;
  New York; Newark; Norfolk; San Antonio; Seattle; and Washington, D.C.

Source: Drug Abuse Warning Network, Office of Applied Studies, Substance
Abuse and Mental Health Services Administration.
============================================================================

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Table_2
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TABLE 2. Estimated number and rate * of methamphetamine-related emergency department episodes -- United
States and selected U.S. metropolitan areas, 1991-1994
========================================================================================================
                    1991          1992           1993          1994              1991 to 1994
Metropolitan    ----------     ----------    ----------    ------------     ----------------------------
area             No.  Rate      No.  Rate     No.  Rate      No.  Rate      % Change      p value
--------------------------------------------------------------------------------------------------------
Total U.S.      4887   2.2     6563   2.9    9926   4.3    17,397   7.8        +256          0.01
Phoenix          164   8.6      279  14.5     481  24.7       770  39.3        +370         <0.01
Denver            38   2.6       31   2.1      55   3.7       143   9.5        +276         <0.01
Minneapolis/
 St. Paul         22   1.0       42   1.9      42   1.9        69   3.0        +214          0.01
Seattle           90   5.0       99   5.5     177   9.6       259  14.0        +188         <0.01
Los Angeles/
 Long Beach      506   6.4      828  10.3    1227  15.2      1418  17.4        +180         <0.01
Atlanta           38   1.5       21   0.8      55   2.1       100   3.8        +163          0.01
St. Louis         27   1.2       15   0.7      29   1.3        54   2.4        +100          0.03
San Diego        515  22.9      931  41.1     929  40.6       966  42.1        + 88         <0.01
Dallas            99   4.3       68   2.9      79   3.4       155   6.6        + 57         <0.01
San Francisco    839  56.5      688  45.8     992  65.3      1150  75.4        + 37         <0.01
Philadelphia      92   2.1      142   3.2     110   2.4        86   1.9        -  7          0.83
Other +          154    NA &    105    NA     122    NA       126    NA        - 18
--------------------------------------------------------------------------------------------------------
* Per 100,000 population.
+ The following metropolitan areas each reported <100 cases during 1991-1994:
  Baltimore; Boston; Buffalo; Chicago; Detroit; Miami/Hialeah; New Orleans;
  New York; Newark; and Washington, D.C.
& Not available.

Source: Drug Abuse Warning Network, Office of Applied Studies, Substance Abuse and Mental Health
Services Administration.
========================================================================================================

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