Lara N Coughlin1,2, Lan Zhang3, Amy S B Bohnert3,4, Donovan T Maust3,2,5, Jason Goldstick2, Lewei Allison Lin1,3,2. 1. Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. 2. University of Michigan Injury Prevention Center, Ann Arbor, MI, USA. 3. Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA. 4. Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. 5. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND AND AIMS: This study aimed to (1) describe trends in stimulant-alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant-related overdose death profiles. DESIGN: Retrospective cohort study of patients who died from stimulant-involved overdose between annual years 2012 and 2018. SETTING: United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant-involved overdose, as identified through the National Death Index. MEASUREMENTS: Stimulant-involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co-involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. FINDINGS: The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine-involved overdoses, methamphetamine-involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06-0.87 aged 65+ versus 18-29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43-5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41-0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29-0.68). CONCLUSIONS: The rate of deaths among US Veterans from stimulant-related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health-care use, point to distinct treatment needs based on stimulant use type.
BACKGROUND AND AIMS: This study aimed to (1) describe trends in stimulant-alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant-related overdose death profiles. DESIGN: Retrospective cohort study of patients who died from stimulant-involved overdose between annual years 2012 and 2018. SETTING: United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant-involved overdose, as identified through the National Death Index. MEASUREMENTS: Stimulant-involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co-involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. FINDINGS: The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine-involved overdoses, methamphetamine-involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06-0.87 aged 65+ versus 18-29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43-5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41-0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29-0.68). CONCLUSIONS: The rate of deaths among US Veterans from stimulant-related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health-care use, point to distinct treatment needs based on stimulant use type.
Authors: Alex S Bennett; Honoria Guarino; Peter C Britton; Dan O'Brien-Mazza; Stephanie H Cook; Franklin Taveras; Juan Cortez; Luther Elliott Journal: Ann Med Date: 2022-12 Impact factor: 5.348
Authors: P Todd Korthuis; Ryan R Cook; Canyon A Foot; Gillian Leichtling; Judith I Tsui; Thomas J Stopka; Judith Leahy; Wiley D Jenkins; Robin Baker; Brian Chan; Heidi M Crane; Hannah L Cooper; Judith Feinberg; William A Zule; Vivian F Go; Angela T Estadt; Robin M Nance; Gordon S Smith; Ryan P Westergaard; Brent Van Ham; Randall Brown; April M Young Journal: JAMA Netw Open Date: 2022-08-01