Research shows that 79% of individuals who use drugs in rural areas across the US reported using methamphetamine within the past 30 days.
Among individuals in rural areas who experienced nonfatal overdose between 2018 and 2020, 22% reported using both opioids and methamphetamine, while 14% used opioids alone and 6% used methamphetamine alone.
The most effective treatment for patients who misuse methamphetamine are behavioral therapies. Studies also suggest the potential for bupropion and naltrexone to serve as pharmacological treatments for methamphetamine misuse.
Although health systems have bolstered efforts to address opioid misuse, research shows that methamphetamine misuse should also be prioritized in substance abuse treatment plans and harm reduction.
As researchers test medicinal treatments, clinicians can employ behavioral therapies to treat patients who struggle with methamphetamine misuse.
Methamphetamines growing in popularity
Between April 2020 and March 2021, 100,306 individuals died of an overdose in the US—marking the deadliest year for patients struggling with substance misuse.
And while the opioid crisis has received ample media attention, opioids aren't the sole driver of overdoses—especially in rural communities.
According to a 2022 survey published by JAMA Open Network, nonfatal overdose among patients in rural areas was greatest in those using both methamphetamine and opioids (22%). Just 6% of those who experienced nonfatal overdose had used methamphetamine alone, and 14% had used opioids alone.
Those who used both drugs had the least access to treatment, and nearly four out of five participants reported using methamphetamine within the past 30 days.
Research shows that the growing prevalence of methamphetamine use among rural populations mirrors the data published by the National Survey on Drug Use and Health. It also indicates individuals who use heroin are more likely to co-use with methamphetamines.
Although methamphetamines are notoriously popular among individuals who use drugs in rural Oregon, the presence of methamphetamine is steadily growing eastward.
As noted by JAMA, methamphetamine-related hospitalizations across the country have risen 270% between 2007–2015.
In the authors’ words, the survey results “document pervasive co-use of methamphetamine and opioids associated with nonfatal overdose among people who use drugs in rural communities.”
Drug treatment programs and harm-reduction efforts—especially those in rural areas—may therefore better serve patients by addressing methamphetamine misuse in addition to opioid misuse.
Treatments on the horizon
Behavioral therapies are the current standard in treatment for methamphetamine misuse.
According to an article published by the National Institute on Drug Abuse, cognitive behavioral therapy and contingency management interventions are the most effective forms of treatment.
One example of a program that employs behavioral therapies is the Matrix Model. It provides patients with 16 weeks of behavioral therapy, family education, individual counseling, a 12-step program, and access to drug testing. It also encourages patients to pursue non-drug-related activities.
Contingency management interventions such as Motivational Incentives for Enhancing Drug Abuse Recovery (MIEDAR) implement incentive-based methods for abstaining from cocaine and methamphetamines. Through NIDA’s National Drug Abuse Clinical Trials Network, MIEDAR has proven effective for those who use methamphetamine.
In addition to therapies and contingency management interventions, potential medicinal treatments for methamphetamine misuse are on the horizon.
A study published by the New England Journal of Medicine stated that the combination of bupropion (“a stimulant-like antidepressant”) and naltrexone (“an opioid-receptor antagonist”) may serve as treatment for methamphetamine misuse in the future.
The study’s first stage showed that 16.5% of participants who had been treated with naltrexone-bupropion had a response, while just 3.4% of the placebo group did. These percentages dropped slightly in the second stage to 11.4% and 1.8%, respectively.
The study authors defined a “response” as “valid negative urine samples obtained after only 4 to 6 weeks in each stage of the trial.”
"In persons with moderate or severe methamphetamine use disorder, treatment with the combination of extended-release injectable naltrexone and daily oral extended-release bupropion over a period of 12 weeks resulted in a higher response than placebo."
— Trivedi, et al.
The future of medicinal treatments for methamphetamine misuse is up in the air. For now, clinicians may employ the NIH’s suggestion to implement behavioral therapies and contingency management interventions for patients who struggle with methamphetamine misuse.
What this means for you
Research suggests that individuals who use drugs in rural areas are more likely to suffer a nonfatal overdose through use of opioids and methamphetamine, signaling the need for a greater focus on methamphetamines in substance misuse treatment and harm reduction efforts. If you have patients who struggle with methamphetamine-related substance misuse, behavioral therapies are recommended treatment. The combination of bupropion-naltrexone as a medicinal treatment for methamphetamine use is currently undergoing clinical trials.