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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Increasing Morbidity and Mortality Associated with Abuse of Methamphetamine -- United States, 1991-1994Methamphetamine (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 NoteEditorial 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
Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. 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. ============================================================================ Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
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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