National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland.
Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Psychiatry. 2021 Dec 1;78(12):1329-1342. doi: 10.1001/jamapsychiatry.2021.2588.
IMPORTANCE: Mortality associated with methamphetamine use has increased markedly in the US. Understanding patterns of methamphetamine use may help inform related prevention and treatment. OBJECTIVE: To assess the national trends in and correlates of past-year methamphetamine use, methamphetamine use disorder (MUD), injection, frequent use, and associated overdose mortality from 2015 to 2019. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed methamphetamine use, MUD, injection, and frequent use data from participants in the 2015 to 2019 National Surveys on Drug Use and Health (NSDUH). Mortality data were obtained from the 2015 to 2019 National Vital Statistics System Multiple Cause of Death files. EXPOSURES: Methamphetamine use. MAIN OUTCOMES AND MEASURES: Methamphetamine use, MUD, injection, frequent use, and overdose deaths. RESULTS: Of 195 711 NSDUH respondents aged 18 to 64 years, 104 408 were women (weighted percentage, 50.9%), 35 686 were Hispanic individuals (weighted percentage, 18.0%), 25 389 were non-Hispanic Black (hereafter, Black) individuals (weighted percentage, 12.6%), and 114 248 were non-Hispanic White (hereafter, White) individuals (weighted percentage, 60.6%). From 2015 to 2019, overdose deaths involving psychostimulants other than cocaine (largely methamphetamine) increased 180% (from 5526 to 15 489; P for trend <.001); methamphetamine use increased 43% (from 1.4 million [95% CI, 1.2-1.6 million] to 2.0 million [95% CI, 1.7-2.3 million]; P for trend = .002); frequent methamphetamine use increased 66% (from 615 000 [95% CI, 512 000-717 000] to 1 021 000 [95% CI, 860 000-1 183 000]; P for trend = .002); methamphetamine and cocaine use increased 60% (from 402 000 [95% CI, 306 000-499 000] to 645 000 [95% CI, 477 000-813 000]; P for trend = .001); and MUD without injection increased 105% (from 397 000 [95% CI, 299 000-496 000] to 815 000 [95% CI, 598 000-1 033 000]; P for trend = .006). The prevalence of MUD or injection surpassed the prevalence of methamphetamine use without MUD or injection in each year from 2017 to 2019 (60% to 67% vs 37% to 40%; P for trend ≤.001). Adults with MUD or using injection were more likely to use methamphetamine frequently (52.68%-53.84% vs 32.59%; adjusted risk ratio, 1.62-1.65; 95% CI, 1.35-1.94). From 2015 to 2019, the adjusted prevalence of MUD without injection more than tripled among heterosexual women (from 0.24% to 0.74%; P < .001) and lesbian or bisexual women (from 0.21% to 0.71%; P < .001) and more than doubled among heterosexual men (from 0.29% to 0.79%; P < .001) and homosexual or bisexual men (from 0.29% to 0.80%; P = .007). It increased over 10-fold among Black individuals (from 0.06% to 0.64%; P < .001), nearly tripled among White individuals (from 0.28% to 0.78%; P < .001), and more than doubled among Hispanic individuals (from 0.39% to 0.82%; P < .001). Risk factors for methamphetamine use, MUD, injection, and frequent use included lower educational attainment, lower annual household income, lack of insurance, housing instability, criminal justice involvement, comorbidities (eg, HIV/AIDS, hepatitis B or C virus, depression), suicidal ideation, and polysubstance use. CONCLUSIONS AND RELEVANCE: This cross-sectional study found consistent upward trends in overdose mortality, greater risk patterns of methamphetamine use, and populations at higher risk for MUD diversifying rapidly, particularly those with socioeconomic risk factors and comorbidities. Evidence-based prevention and treatment interventions are needed to address surges in methamphetamine use and MUD.
重要性：在美国，与甲基苯丙胺使用相关的死亡率显著增加。了解甲基苯丙胺使用模式可能有助于为相关预防和治疗提供信息。
目的：评估 2015 年至 2019 年期间过去一年中甲基苯丙胺使用、甲基苯丙胺使用障碍（MUD）、注射、频繁使用和相关过量死亡的全国趋势和相关因素。
设计、地点和参与者：本横断面研究分析了 2015 年至 2019 年全国药物使用和健康调查（NSDUH）中参与者的甲基苯丙胺使用、MUD、注射和频繁使用数据。死亡率数据来自 2015 年至 2019 年国家生命统计系统多原因死亡文件。
暴露因素：甲基苯丙胺使用。
主要结果和测量：甲基苯丙胺使用、MUD、注射、频繁使用和过量死亡。
结果：在 18 至 64 岁的 195711 名 NSDUH 受访者中，有 104408 人是女性（加权百分比，50.9%），35686 人是西班牙裔个体（加权百分比，18.0%），25389 人是非西班牙裔黑人（简称黑人）（加权百分比，12.6%），114248 人是非西班牙裔白人（简称白人）（加权百分比，60.6%）。2015 年至 2019 年，涉及除可卡因以外的精神兴奋剂（主要是甲基苯丙胺）的过量死亡人数增加了 180%（从 5526 人增至 15489 人；趋势 P<0.001）；甲基苯丙胺使用人数增加了 43%（从 140 万人（95%CI，120 万至 160 万人）增至 200 万人（95%CI，170 万至 230 万人）；趋势 P=0.002）；频繁使用甲基苯丙胺的人数增加了 66%（从 61.5 万人（95%CI，51.2 万至 71.7 万人）增至 102.1 万人（95%CI，86 万至 118.3 万人）；趋势 P=0.002）；甲基苯丙胺和可卡因的使用人数增加了 60%（从 40.2 万人（95%CI，30.6 万至 49.9 万人）增至 64.5 万人（95%CI，47.7 万至 81.3 万人）；趋势 P=0.001）；无注射 MUD 的人数增加了 105%（从 39.7 万人（95%CI，29.9 万至 49.6 万人）增至 81.5 万人（95%CI，59.8 万至 103.3 万人）；趋势 P=0.006）。从 2017 年到 2019 年，MUD 或注射的流行率每年都超过了无 MUD 或注射的甲基苯丙胺使用的流行率（60%至 67%对 37%至 40%；趋势 P≤0.001）。有 MUD 或使用注射的成年人更有可能频繁使用甲基苯丙胺（52.68%至 53.84%对 32.59%；调整风险比，1.62-1.65；95%CI，1.35-1.94）。从 2015 年到 2019 年，异性恋女性（从 0.24%增至 0.74%；P<0.001）和女同性恋或双性恋女性（从 0.21%增至 0.71%；P<0.001）以及异性恋男性（从 0.29%增至 0.79%；P<0.001）和男同性恋或双性恋男性（从 0.29%增至 0.80%；P=0.007）中，无注射 MUD 的调整后流行率增加了两倍以上。黑人群体中的增幅超过 10 倍（从 0.06%增至 0.64%；P<0.001），白人群体中的增幅接近三倍（从 0.28%增至 0.78%；P<0.001），西班牙裔个体中的增幅超过两倍（从 0.39%增至 0.82%；P<0.001）。甲基苯丙胺使用、MUD、注射和频繁使用的危险因素包括教育程度较低、家庭年收入较低、缺乏保险、住房不稳定、刑事司法涉案、合并症（如艾滋病毒/艾滋病、乙型或丙型肝炎病毒、抑郁症）、自杀意念和多物质使用。
结论和相关性：本横断面研究发现，过量死亡、更高风险模式的甲基苯丙胺使用以及风险更高的 MUD 人群迅速多样化，特别是那些具有社会经济风险因素和合并症的人群，呈持续上升趋势。需要基于证据的预防和治疗干预措施来应对甲基苯丙胺使用和 MUD 的激增。
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