Longitudinal changes in co-involved drugs, comorbidities, and demographics of methamphetamine-related deaths in Los Angeles County

Chelsea L Shover; Joseph R Friedman; Ruby Romero; Russell Buhr; Brian Chu; Amber Tang; Jesus A Medina; Lauren Wisk; Jonathan Lucas; David Goodman-Meza

doi:10.1016/j.josat.2023.209101

Longitudinal changes in co-involved drugs, comorbidities, and demographics of methamphetamine-related deaths in Los Angeles County

J Subst Use Addict Treat. 2023 Aug:151:209101. doi: 10.1016/j.josat.2023.209101. Epub 2023 Jun 12.

Authors

Affiliations

¹ Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA. Electronic address: clshover@mednet.ucla.edu.
² UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
³ Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
⁴ Division of Pulmonary and Critical Care, University of California, Los Angeles, CA, USA.
⁵ Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, CA, USA.
⁶ Division of Infectious Diseases, University of California, Los Angeles, CA, USA.

Abstract

Introduction: We conducted a population-based observational study of all medical examiner cases in Los Angeles County from January 2012 through June 2021 in which methamphetamine was listed as a cause of or contributing factor to death (n = 6125). We aimed to characterize demographics, comorbidities, and co-involved substances in methamphetamine-related deaths longitudinally in Los Angeles County, California.

Methods: We used detailed death record data to manually classify fatalities by involvement of each organ system, opioids, alcohol, cocaine, other drugs or medications, and external/traumatic causes. Primary outcomes included: the number of methamphetamine-involved deaths, demographics of decedents, percentage of methamphetamine deaths also involving other drugs, and percentage of methamphetamine deaths involving different organ systems. We performed Mann Kendall tests of trends to identify statistically significant longitudinal changes.

Results: During the study period, the percentage of methamphetamine-related deaths involving opioids significantly increased from 16 % in 2012 to 54 % in 2021 (p < 0.001). Concurrently, the percentage involving cardiovascular causes significantly decreased from 47 % to 26 % (p < 0.05). Methamphetamine-related deaths in LAC increasingly affected people experiencing homelessness, for whom the percentage tripled from 13 % in 2012 to 35 % in 2021. The share of decedents under 40 years old increased from 33 % to 41 %. The percentage of Black or African American decedents increased over five-fold from 3 % to 17 %.

Conclusions: Methamphetamine-related deaths involving opioids more than tripled in Los Angeles County from 2012 to 2021, reflecting the drug supply's shift to illicit fentanyl. More than a quarter involved cardiovascular causes. These findings have implications for treatment and prevention, including scaling up contingency management, distributing naloxone to people who primarily use stimulants, and including cardiovascular care alongside these interventions directly targeted to reduce harms of methamphetamine use.

Keywords: Cardiovascular; Comorbidities; Homelessness; Methamphetamine; Opioids; Overdose; Polysubstance use.

Publication types

Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Adult
Analgesics, Opioid / adverse effects
Demography
Drug Overdose*
Humans
Los Angeles / epidemiology
Methamphetamine* / adverse effects

Substances

Methamphetamine
Analgesics, Opioid

Abstract

Publication types

MeSH terms

Substances

Grants and funding