The rate of stimulant-involved mortality has been increasing rapidly in the United States, according to findings presented in a research letter, published in JAMA Internal Medicine.

Data was sourced from the Drug Involved Mortality database from the National Center for Health Statistics by researchers from the Rocky Mountain Poison and Drug Safety Division of Denver Health. All drug-related deaths in the United States between 2010 and 2017 were assessed by annual rate ratios (ARRs).

During this time period, 1,220,143 deaths were reported to be associated with drugs. Stimulants were involved in 10.7% of these deaths.

Among the deaths involving stimulants, 71.8% were among men aged median 45 (interquartile range [IQR], 34-54) years and 75.5% were White. The vast majority (92.5%) of these deaths involved illicit stimulants, such as cocaine (61.9%) and methamphetamine (39.9%), 4.2% involved medical stimulants, and 2.7% involved both illicit and medical stimulants.


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The medical stimulants involved with deaths were mostly amphetamine (90.9%), followed by methylphenidate (0.3%) and pseudoephedrine (0.7%).

Medical and illicit stimulant deaths frequently involved co-use of opioids (54.1% and 43.2%), benzodiazepines (26.8% and 9.6%), and antidepressants (13.2% and 3.1%), respectively.

Since 2010, annual deaths involving stimulants has increased from 2.913 deaths per 100,000 to 9.690 deaths per 100,000 in 2017.

Stratified by drug type, the ARR of methamphetamine was 1.278 (95% CI, 1.261-1.295), cocaine was 1.234 (95% CI, 1.222-1.245), medical stimulants were 1.226 (95% CI, 1.202-1.250), and amphetamine was 1.118 (95% CI, 1.082-1.155). For all of these stimulants, except amphetamine, these ARRs corresponded with a doubling of mortality every 4 years (ARR ³1.20).

This study may have been confounded by the fact that amphetamine is in the same metabolic pathway as other stimulants and misidentification of some deaths could not be excluded.

The study authors concluded the rise of stimulant-related deaths has been escalating quickly in the US, even more rapidly than deaths due to opioids in the early 2000’s prior to the opioid epidemic.

No medications have been approved for the treatment of stimulant use disorder. Additional studies are needed to address identification and treatment of stimulant use disorder in order to ameliorate the concerning trajectory of stimulant-involved deaths in the US.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Black JC, Bau GE, Iwanicki JL, Dart RC. Association of medical stimulants with mortality in the US From 2010 to 2017. JAMA Intern Med. Published online February 1, 2021. doi:10.1001/jamainternmed.2020.7850.