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How Do You Know if You Take Too Much Meth

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"It'south called overamping": experiences of overdose among people who use methamphetamine

  • Katherine T. Wagner2,
  • Phillip Fiuty3,
  • Krysti P. Smithane,
  • Kimberly Folio2 &
  • Karla D. Wagner ORCID: orcid.org/0000-0002-8614-2004 i

Harm Reduction Periodical volume 19, Article number:4 (2022) Cite this article

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Abstruse

Groundwork

The The states is experiencing increases in methamphetamine use and methamphetamine-related or attributed deaths. In the current study, nosotros explore qualitative narratives of methamphetamine overdose and strategies used by people who use drugs to reduce the undesirable effects associated with methamphetamine use.

Methods

We conducted 21 qualitative interviews with people over the age of 18 who reported using methamphetamine in the previous 3 months in Nevada and New Mexico. Interviews were recorded, transcribed, and analyzed using qualitative thematic analysis.

Results

Respondents described a constellation of psychological and physical symptoms that they characterized equally "overamping," experienced on a continuum from less to more than severe. Reports of acute, fatal methamphetamine overdose were rare. Few reported seeking medical attention for undesirable furnishings (usually related to psychological furnishings). General self-care strategies such as sleeping and staying hydrated were discussed.

Conclusions

When asked directly, our respondents claimed that astute, fatal methamphetamine overdose is rare or even incommunicable. However, they described a number of undesirable symptoms associated with overconsumption of methamphetamine and had few clinical or harm reduction strategies at their disposal. Addressing this electric current wave of drug-related deaths volition require attention to the multiple factors that structure experiences of methamphetamine "overdose," and a collaborative effort with PWUDs to devise effective damage reduction and handling strategies.

Background

Amphetamine type stimulants account for a significant share of illicit drug employ globally [1,ii,3,4,5]. Among amphetamine type stimulants, the virtually widely and commonly used is methamphetamine [five]. In the early 2000s, the highest prevalence of methamphetamine use was in Asian Regions [ii]. Since then, methamphetamine use has been expanding in other regions of the globe [3, 4]. The UN Role on Drugs and Crime has been noting increasing use of amphetamine type stimulants, especially methamphetamine, for over a decade [ii]. In 2019, an estimated 27 meg persons worldwide used methamphetamine, with the highest prevalence occurring in N America [3].

In fact, the USA experienced a 198% increase in use of amphetamine type stimulants between 2010 and 2019, driven primarily by methamphetamine [6]. Following earlier trends in opioid-related morbidity and bloodshed, where initial increases were most dramatic in smaller rural communities, rural and non-metro counties have also seen the largest increases in methamphetamine use per capita [7,8,9]. In the USA, rural and non-metro counties typically have far fewer substance use disorder handling, harm reduction, and healthcare services, making acceptable response to drug-related morbidity and mortality more than difficult. Despite the higher rates of apply in rural counties compared to urban, nigh methamphetamine enquiry in the U.s.a. has been conducted with urban sexual minorities in the context of HIV prevention inquiry [10,11,12,xiii] and has not sufficiently explored the phenomenon of methamphetamine use among other populations of users.

Use of methamphetamine is associated with multiple morbidities, including: psychiatric symptoms (hallucinations, delusions, anxiety, and depression) [xiv, xv], physical concerns (hypertension, increased take a chance of intracranial hemorrhagic stroke, cardiomyopathy, renal failure, ischemic center disease), and increased take chances of suicide and injury [15,16,17,xviii,19,20]. In recent years, Us surveillance reports have identified increases in methamphetamine-related hospital and substance use disorder admissions. For example, from 2010 to 2017 in Washington land in the Western USA, the historic period-adjusted rate for methamphetamine-involved hospitalizations increased from vi.three to 8.five/100,000 [21]. Nationally, hospital admissions for centre failure involving methamphetamine increased from 547 in 2002 to 6625 in 2014 [22]. Amidst people seeking substance use disorder treatment for heroin, the proportion of patients reporting methamphetamine utilise increased nearly 500% betwixt 2008 and 2017 [7].

Vital statistics records take also demonstrated dramatic increases in methamphetamine-related or involved deaths in the U.s. [23]. Methamphetamine-related deaths increased almost five-fold, from 0.8 per 100,000 in 2012 to iii.9 per 100,000 in 2018 [24]. Notably, a meaningful share of drug overdose deaths now includes combinations of opioids and stimulants and, particularly in the Western U.s., opioids and methamphetamine are frequently consumed together [25, 26]. Even so, while opioid overdose has been clinically divers and death is understood to upshot from opioid-induced respiratory low, methamphetamine-related fatalities are not as amenable to easy identification. Specifically, the toxicity of methamphetamine, levels of fatal claret concentrations, and the contribution of other substances and underlying comorbidities create a less straightforward picture when trying to understand methamphetamine-related deaths. A vii-twelvemonth study of autopsies for methamphetamine-related deaths in Australia (2009–2015) found that in 83% of cases, other substances were detected in postmortem toxicology (by and large opioids and hypnosedatives); methamphetamine toxicity lone was identified as cause of death in a minority (6.1%) of cases [16]. Importantly, amidst the 1649 descendants in the Australian report, causes of death other than toxicity (e.one thousand., coronary disease, cardiovascular injury, suicide, or injury) accounted for a big share of deaths. This suggests that effects other than astute methamphetamine toxicity from an overdose could explain many methamphetamine-related deaths.

Contempo qualitative research has identified motivations for methamphetamine use and described the experiences of users [27,28,29,thirty,31,32,33,34,35]. However, less is known about the experiences of methamphetamine overdose among the electric current population of people using it. This knowledge gap has of import implications for the implementation of constructive public health strategies to reduce morbidity and mortality associated with methamphetamine utilise. Specifically, unlike naloxone administration for opioid overdoses, which is relatively straightforward and can be implemented by laypeople, including people who use drugs [36,37,38], there is no analogue to naloxone for the handling of the acute furnishings of methamphetamine overdose. The presentation of a methamphetamine overdose is not as acquiescent to easy recognition and layperson response due to the complicated pathophysiology, role of polysubstance utilize, impact on multiple systems, and exacerbation of underlying chronic morbidity. This is particularly relevant as communities attempt to calibration up harm reduction measures to reduce methamphetamine-related morbidity. Developing patient-centered methamphetamine overdose prevention strategies requires an understanding of how people who use methamphetamine define and experience the furnishings of methamphetamine overdose, and what they do to mitigate unwanted furnishings.

In the electric current study, we explore qualitative narrative accounts of methamphetamine overdose and strategies to reduce the undesirable effects associated with methamphetamine use. Data were drawn from a larger, mixed methods study to examine the patterns of methamphetamine utilise, perceived methamphetamine-related harms and benefits, and harm reduction strategies in two communities characterized by high rates of methamphetamine and opioid use [viii, 39,40,41,42,43,44,45]. Nosotros conducted qualitative interviews with people who utilise methamphetamine to accost the following enquiry questions: (one) what are people's experiences with methamphetamine use and overdose and (two) how do people who utilize methamphetamine manage the harms or undesirable symptoms associated with methamphetamine overdose?

Methods

Setting

This sequential mixed methods study was carried out in two Western states: Nevada and New Mexico, where media and local surveillance data indicate loftier rates of opioid overdose deaths and rising rates of methamphetamine-related expiry. Our university-based research teams in both locations collaborate with local community partners, including public health authorities, substance employ disorder handling providers, and harm reduction service agencies, through both formal and informal partnerships. For this study, customs partners were included in the conceptualization, design, and implementation of the study and too allowed the research team to access to their facilities for participant recruitment and data drove activities. All study activities were approved past the University of Nevada, Reno (UNR) Institutional Review Board (IRB). The University of New Mexico IRB deferred oversight to UNR IRB under a unmarried IRB understanding.

Recruitment and data collection

Between Dec 2019 and February 2020, we recruited people utilizing a combination of street and bureau-based outreach in both locations. Inclusion criteria were historic period 18 years and older and self-reported methamphetamine utilize in the past 3 months. Recruitment included providing flyers and conducting one-on-one outreach in locations known to be frequented by people who utilize methamphetamine, including encampments of people experiencing homelessness, syringe service programs, and bars. We also conducted chain-referral recruitment through existing participants.

Data were collected past trained qualitative interview staff using a loosely structured interview guide, in a private or semi-private location that was acceptable to the participants. In some cases, interviews were conducted in individual rooms at our partner agencies' offices, while in others they were conducted exterior (e.one thousand., in an encampment, at a participants' home). All participants completed the interview in English, though everyone was provided the option to have data collected in English or Spanish. Written informed consent was obtained from all enrollees. To guard against perceptions of coercion, participants were compensated $40 immediately upon providing consent and were reminded that they could cease the interview at any time without question or consequences.

Kickoff, we collected a minor set of quantitative demographic variables including age, gender, sexual activity, ethnicity, race, residential location, homelessness, education, employment, recent incarceration, and access to healthcare services. Then, the qualitative interview began with broad questions about the respondents' drug use, including reasons for using methamphetamine, electric current drug use patterns, and changes over time. Almost relevant to the current analysis, we asked iv questions related to methamphetamine overdose and other negative experiences: (1) What kinds of drawbacks or negative experiences are yous having from your methamphetamine use right now, or take you experienced in the past?; (2) Take you or anyone you know experienced what y'all believe to exist a methamphetamine overdose? What did that look like or feel like?; (iii) Can you tell me about your experiences seeking medical care for any issues associated with your drug use?; and (4) What strategies accept you used to reduce any harms or negative experiences associated with your methamphetamine use?

Analysis

Interviews were digitally recorded and transcribed verbatim for analysis. Later conducting quality assurance review and redaction of the transcripts, information were analyzed using an anterior thematic arroyo. Guided past our research questions, a single annotator reviewed all the transcripts and began by making a series of memos documenting initial impressions. Those memos were discussed with the entire research team, which includes researchers and service providers, some of whom have lived and living experience of substance use. The annotator developed a set of thematic codes, arranged into a hierarchical categorization scheme, which they practical systematically to all the transcripts. Afterwards an initial circular of coding, the coded transcripts were reviewed and discussed with team members and codes were farther divers and refined, while memos were expanded to capture emergent ideas. Finally, the analyst and i report PI, a mixed methods researcher with 20 years of qualitative enquiry experience, collaboratively organized the output from the coding and identified commonalities across the narratives and illustrative quotes. Quotes are provided using a unique respondent identifier (eastward.g., "R13"), ethnicity, race, sex, age, location of interview, and drugs used most often by the respondent.

Results

We interviewed 21 people (eleven from Nevada, 10 from New United mexican states). Respondents were 48% female person and 52% male person. In terms of race and ethnicity, 2 participants were blackness, 10 were white, 3 were multiracial, and 6 were Latinx. Median age was 35 years (IQR: 30–43). Simply under half (48%) reported existence homeless, 81% had completed 12 years or more than of formal education, and 38% were employed full or role time. The majority (17/21) reported using mostly methamphetamine and opioids (including heroin, methadone, and prescription opioids); merely four reported using methamphetamine alone.

Experiences of overdose

When asked whether they or anyone they know had experienced what they believe to be a methamphetamine overdose, reports of fatal acute methamphetamine overdose were rare and some respondents asserted that a methamphetamine overdose is "not possible." For instance, when asked whether he had ever experienced a methamphetamine overdose, one respondent said:

"You tin't OD on meth. I don't care what they say. You fucking nod the fuck out. Maybe you have a weak centre or something or it gives out, okay, then yeah, y'all dice, whatever. But y'all should[n't] be doing that [dying of an overdose]."

R13, Non-Hispanic/Latino, White, Male, 30s, Nevada, MA+heroin

He went on to distinguish the experience of "overdosing" from the experience of "overamping," which he describes as the body "shutting down" due to the over-stimulation:

"They nod out. Information technology's called overamping. Overamping, okay? You hit, your body [inaudible] because you had so much energy, your body can't take it. Your body will merely shut the fuck down. Your heart cannot have that concrete fucking rush and people will shut downwards, they go to sleep."

R13, Non-Hispanic/Latino, White, Male, Nevada, MA+heroin

In simply 2 of the 21 interviews did respondents describe what appeared to be a fatal methamphetamine overdose, and both accounts were told second hand (i.e., non direct observed by the respondent); in improver, they both seemed to describe the same event. Details nigh the actual upshot were sparse: the overdose victim was left alone, and the specifics of the death were unclear. In the remaining 19 interviews, respondents described psychological or concrete effects of taking besides much methamphetamine, but in general these were described as not-life-threatening experiences. In the sections that follow, we report in more than detail the spectrum of symptoms associated with what many respondents described every bit "overamping." We categorize these experiences in terms of whether they are experienced primarily as psychological or physical symptoms (though often there is overlap), and analyze each in terms of their desirability, uncomfortableness, level of business concern about health/rubber, and perceived demand to seek emergency medical intervention.

Psychiatric effects

One common gear up of experiences were psychiatric furnishings. For the most function, these furnishings were experienced along a continuum, from symptoms that participants described equally less concerning such equally retentivity lapses and anxiety to more than worrisome symptoms including paranoia, delusions, and hallucinations. Respondents who had memory lapses explained that they were like to alcohol-induced blackouts—they forgot what happened, only the feel did not put them in immediate physical jeopardy. One respondent described this feel by proverb that four or five days had passed and they hadn't realized that whatever time had passed. Some other respondent told a story about purchasing a new motorcar, experiencing a memory lapse, and leaving the car abandoned for several days. Three days later she recovered only could not recall where she left her new car. In cases of memory lapses, the respondents describe the experience having a rapid onset, similar a switch clicked off. They might remember having a conversation up to a certain point so forgetting how the chat continued or what happened afterwards that. They might be partying in i part of town and discover themselves across town a day or two later on. None of the respondents talked about experiencing falls or injury during these retentivity lapses, merely one respondent did place the vulnerability of someone in this state, saying:

"…but when y'all overamp and like that, information technology tin be a scary thing because that'south when girls get raped or guys rape, whatever. You don't remember nearly the consequences anymore. You're and so high that whatever matters in that moment is [inaudible] in that moment. That's it."

R10, Non-Hispanic/Latino, White, Male, 20s, Nevada, MA+heroin

Our interview guide did not systematically ask participants nigh alcohol consumption. However, of the four respondents who mentioned memory lapses, just two said they consumed alcohol and ane of them said they had cut back on alcohol use because information technology interfered with the furnishings of other drugs.

More concerning psychiatric effects included paranoia, delusions, and hallucinations. These sometimes happened independently, but could also occur concurrently (delusions/paranoia, delusions/hallucination, etc.). In many cases, respondents interpreted these effects as signs they needed to sleep, only not as life-threatening events that required medical attention. In the post-obit passage a respondent describes an experience of paranoia that was on the less-worrisome end of the spectrum for him:

"That's the level, like in that location'south a level of fear that comes from, for me anyway, I know some people turn into assailment, I turn into sort of introversion where I'm just super scared of everybody. I walk in the store, and oh, my god. Fucking everybody is looking, you lot son of a bitch."

R14, Hispanic/Latino, White, Male person, 30s, Nevada, MA+heroin

Later, this same respondent described a more worrisome experience in which he received medical care following a hallucination in which he believed he had killed someone in a automobile accident. The hallucinations and delusions started in a hotel room. In an attempt to wake himself: he broke things, went to the forepart office naked, and tried to pour h2o on himself. Later on calming him downward a fleck, the motel staff called 911 and he was transported to the hospital, where he continued to experience auditory hallucinations of law enforcement and ER staff conspiring to kill him.

When people sought medical intervention (unremarkably from an emergency room or by calling 911, simply sometimes also from service providers in the community), they experienced that picayune could be done other than to ride it out in a safe environment:

"We had went over there, took my sister over at that place [to the customs program]. She was flipping out. They didn't know what to do. They said, nosotros don't know what to practise about the meth yet. Information technology's a big thing. No one knows how to accost information technology. Everybody's going on these trips and we don't know how to opposite the trip."

R4, Hispanic/Latina, Blackness, Female, 20s, New Mexico, MA+methadone

Other respondents described their hallucinations in spiritual terms. Some respondents saw some hallucinations as welcomed spirits, engaging with them equally if methamphetamine had opened a new spiritual plane.

"I liked it. I liked information technology. It opened my mind to a lot of shit that I didn't see… I was talking to this other guy and he says that he sees like -- I don't know how to explicate it -- like demons. He sees similar this shit that yous never would encounter on straight. And I've talked to more than one person. I don't know what it is. I don't know if it's something that fucks within your heed or if this shit is really at that place or what. I hateful information technology's just weird because a lot of people are saying the same shit. And I don't know if information technology but -- I don't know what information technology is. I was just curious. I always wanted to ask somebody because they say that when you practise meth, it opens you lot to a level, whatever, similar million people that can come across shit. I don't know if that'southward truthful."

R2, Hispanic/Latino, Black, Male, 20s, New Mexico, MA+heroin

Others talked about their hallucinations as more than frightening, including one respondent who idea the devil was coming for her soul.

"Me and him started sliding and we went on a trip, both of the states just I took a little flake harder and I started thinking that my married man was with another girl. I started seeing this other girl. Really, in reality, which there was no other daughter. I started accusing … him of [cheating with] her. I started hearing noises. I would see it. I was seeing things, awful things similar the devil and stuff was trying to set on me. Information technology was atrocious. I've been on an awful trip. It was very scary, and information technology was atrocious, awful."

R7, Hispanic/Latina, White, Female, 40s, New United mexican states, MA+methadone

In the quotation that follows, the same man who described his ain hallucinations in a positive and spiritual mode, described his female person partner'due south hallucinations in a more negative way:

"But terminal night, for whatever reason, she merely flipped out. And I couldn't handle it no more. I told her, 'You're going to have to leave.' It's sad that that was in the center of the dark. It's cold. Merely I couldn't do it no more. I mean I wouldn't even [put up with it with] my ex-married woman and I just tin can't. I can't handle it. It'south pitiful. I experience bad for her because she might be meaning with my kid."

R2, Hispanic/Latino, Black, Male person, 20s, New Mexico, MA+heroin

Though we did not systematically ask participants how their route of administration impacted their experiences with methamphetamine overamping, nearly half of our sample identified injecting (compared to other routes of administration) equally increasing the adventure of delusions, and hallucinations. One person retells the story of his but time injecting methamphetamine. Afterwards, he says this would be the last time he ever injected methamphetamine:

"When was the first 24-hour interval? Oh, I think one time I shot it up. I felt like there was a worm in my eye. And I started flipping. I freaked out. I called the ambulance and I had them go pick me upward. They looked in my eye. They did an ultrasound on the top of my eyelid and there was naught in in that location."

R3, Hispanic/Latino, White, Male, 40s, New Mexico, MA+heroin

As a result, some people stopped injecting and switched to smoking equally a harm reduction response to their negative experiences of hallucinations:

"What's amazing, to be honest with you, afterwards I went on that trip, now that I smoke, information technology's a whole different thing. I don't get high like that no more. … Now, I'k normal. It simply wakes me up a fiddling. That's it. I don't trip. Thank, God. I don't naught. I'yard normal, awake more than."

R7, Hispanic/Latina, White, Female, 40s, New Mexico, MA+methadone

Physical furnishings

Reported physical effects included: a stiff want to slumber, cardiovascular symptoms, and uncontrollable movements of one's face and extremities (which most respondents identified as "flailing"). Reflecting the account discussed before in which a male respondent said that overdose is but the body "shutting down," one of the less-concerning concrete experiences was described as experiencing a potent desire to slumber:

"Basically, where you smoke yourself to sleep or you do too much in a shot and you just become to sleep… And you wake upwardly. Simply when yous wake upwards, you're energized. It's non like the heroin overdose is like where y'all feel shitty afterward. You feel great afterwards. Yous don't feel like you've just been put through information technology. It just basically overamps y'all to where you turn off."

R9 Non-Hispanic/Latina, White, Female person, 30s, Nevada, MA+heroin

While this respondent described waking up feeling groovy, others reported feeling hungover or in withdrawal the following morning. Respondents did non draw experiences consistent with a vasovagal syncope (fainting); rather, they just experienced an uncontrollable desire to sleep. One respondent described it as sensory overload; after days of methamphetamine use and no balance, their torso only could not handle further input and shut-down, like a computer restarting:

"Similar I said, it overwhelms your senses and and then your body. Your body just -- it'southward going besides fast. Your mind is going too fast or something. It shuts off, I estimate. I don't really know the bodily reason why, but you'll see people starting to nod out when they're doing it."

R10, Non-Hispanic/Latino, White, Male person, 20s, Nevada, MA+heroin

In terms of cardiovascular furnishings, one respondent described feeling that his heart would burst through his breast. These experiences were described equally alarming in the moment, simply not life threatening. Most believed that these experiences would laissez passer, and in fact, they did. Though rare, one respondent described offering street remedies for people experiencing cardiovascular effects:

"I got high with a couple of people that aren't used to getting high the way we do. They'll say, 'Well, what…' They'll ask questions like, 'What practice yous do if you get smoke as well much? Or how do you lot know y'all're having a heart attack?' My communication to them was get a Benadryl and let it dissolve under your tongue and information technology does aid. I've seen information technology help or drinking glass of a milk. That calms the heart rate. I've seen people but freak out considering they think they've washed likewise much. Thankfully, I calm down by doing that. Merely other, if they don't know what to do in a state of affairs similar that, and then they probably have a panic attack and stop up in the hospital."

R8, Hispanic/Latina, White, Female person, 30 s, New Mexico, MA + heroin.

Flailing, or equally one respondent called it "hick-a-booing," describes muscle spasms causing a person's arms, legs, or jaw to move quickly, wildly, and without purpose or intent. In most interviews, respondents described "flailing" every bit an unpleasant experience.

"It's when you lot exercise a shot and you're coming really fucking loftier pretty much. It never goes abroad. You never stop interim that way. There was one time where I got similar – I felt like I was [inaudible]. I tin't stop rocking back and forth. I tin can see myself doing it, spotter myself doing information technology but I couldn't stopped doing. I don't know what it was. I just couldn't fucking finish. Honestly, it was fucking – it scared the shit out of me…Similar, "Stop doing that. Cease doing it." Simply I tin can't fucking – it was a psychosis thing. I started freaking out. Then that can get even worse when y'all do it more."

R10, Non-Hispanic/Latino, White, Male person, 20s, Nevada, MA+heroin

While unpleasant, few individuals expressed concern for their health or safety in a moment of flailing, well-nigh stating that they just needed to ride it out. For some of our respondents, the lack of command over their movements was itself a crusade for business organisation, in that it signaled to others that the person was using methamphetamine. In some cases, flailing co-occurred with psychological effects, such as memory blackouts and delusions as described above.

The role of sleep deprivation, dehydration, and hunger

Rather than attributing the psychiatric and physical symptoms to methamphetamine utilise or overdose, most respondents associated these symptoms with the cumulative outcome of being awake for several days while binging on methamphetamine, during which fourth dimension they became dehydrated or undernourished.

"Hydration. [crosstalk] Sort of a rationalization of sort of acceptance well-nigh okay, if the cops are behind me, they're behind me. If they say it's going [inaudible] and it's just going to happen. I know it's not actually going through but information technology was simply saying okay, trying to pretend that you're [inaudible], I estimate. I mean literally staying hydrated and having nutrition [inaudible] I guess my torso was just in a point of severe, severe similar ii, three days without water walking around"

R14, Hispanic/Latino, White, Male, 30s, Nevada, MA+heroin

This feel was described as unique to methamphetamine, and linked to the common experience of staying awake for several days while using methamphetamine. For instance, one respondent compared the experiences using methamphetamine and cocaine:

"That paranoia comes with the meth after a couple of days awake. Of form, your listen's in a [inaudible] with y'all. You haven't slept. So that's when paranoia comes in with that. Then for coke, information technology's just boom, hits y'all similar that. One time you accept that first hit, you get paranoia. You see a shadow. You fucking think someone's coming or they're out to get yous or just any. It'south weird."

R8, Hispanic/Latina, White, Female, 20s, New Mexico, MA+heroin

In well-nigh cases, respondents did not experience symptoms until they had been awake for ii to 3 days. For some, the onset of such symptoms signaled the need to go some remainder and stop using for a while.

"After i or two days, I take to take a intermission because I just don't similar going on days without sleep. It's only the mental side effects for me personally are just outrageous if not careful with it. I terminate upward losing jobs because if you spooked out to go to work and I feel like but grandiose far out paranoia usually if I'm not careful with it."

R11, Non-Hispanic/Latino, Black, Male, 20s, Nevada, MA+heroin

"Yeah. If I'one thousand up for three days or any and I start looking at the door handle like that, I'll think information technology starts to movement, like someone's going to come up or starting the door lock going similar, "Ta-da." It'south crazy. So nothing happens. Like I said, my friend's been like, "Look, look." She's showing me something on her finger. Y'all stay looking long enough and you get-go thinking y'all come across information technology moving like footling worm or whatever. Oh, my God. Then it'south like, "No, it's non there. Look at that shit when you're sober."

R8, Hispanic/Latina, White, Female, 20s, New Mexico, MA+heroin

Word

We interviewed 21 people who use methamphetamine in Nevada and New Mexico to elucidate experiences they described as methamphetamine "overdose" and the ways in which people manage or reduce their adventure of experiencing negative furnishings. Our goal was to arm-twist PWUDs' perspectives on this outcome, which should be centered when informing funding, policy, and programmatic initiatives. Notably, nearly all of our respondents (17/21) reported utilise of opioids and methamphetamine—only four reported just using methamphetamine. When asked about their experiences of methamphetamine overdose, our respondents asserted that experiences of acute fatal methamphetamine-only overdose are rare and none described what could be interpreted equally a polydrug overdose with methamphetamine and opioids.

It may be that the feel of methamphetamine "overdose" cannot be described using the same framework that is currently used to depict opioid overdose. The primary effects of opioid agonists such as heroin include analgesia, euphoria, and respiratory depression [46]. On the other mitt, methamphetamine has both acute and chronic effects on the cardiovascular and cerebrovascular systems [20], and has been implicated in various underlying cardiac and cerebrovascular diseases that result in death [47]. While fatal opioid overdose manifests in the form of acute respiratory low resulting speedily in death without intervention, methamphetamine "overdose" might exist more accurately described every bit a constellation of psychological and physical symptoms that are experienced on a continuum from less to more severe. A more businesslike and patient-centered approach might be to admit and address the cumulative furnishings of methamphetamine employ as a risk factor for the cardiovascular and cerebrovascular systems [48], while also addressing the positive and negative behavioral, physical, and psychiatric consequences of its use.

Of note, many of the symptoms described by our sample could be owing to other causes, such equally farthermost slumber deprivation and/or polysubstance use, rather than the acute effects of methamphetamine utilize alone. Auditory and visual delusions and hallucinations accept been experienced by individuals suffering extreme sleep impecuniousness [49], and lack of sleep is a risk cistron for anxiety, and major low [50, 51]. Therefore, it is difficult to make up one's mind if methamphetamine use itself, or the sleep deprivation brought on past its use, is the more proximal cause of symptoms experienced in our sample. Future research should determine if behavioral health interventions to improve sleep patterns could consequence in fewer negative psychological symptoms experienced by people using methamphetamine. Similarly, the memory lapses described by our participants as "blackouts" might be the result of excessive alcohol consumption. However, our data do not propose that alcohol consumption was a major factor among those who described this experience.

A primary finding from our report is that, while accounts of acute fatal methamphetamine overdose were rare, respondents did experience a range of undesirable and potentially harmful symptoms, and respondents were enlightened of few clinical or harm reduction strategies to reduce those negative consequences. One respondent recommended the use of antihistamines for reducing cardiovascular symptoms associated with overconsumption, though clinical guidance for this pharmaceutical intervention is defective. Otherwise, respondents identified general cocky-care strategies such as sleeping and staying nourished and hydrated. Some respondents were unable to identify any clinical or harm reduction therapeutics, a arrears which was also described when respondents sought medical care and found little assist bachelor. There is a critical need for efforts that collaborate with people who use methamphetamine to identify effective clinical and impairment reduction strategies that draw upon and eye their expertise, while preserving autonomy and self-determination [52, 53].

Our findings must exist interpreted in light of a significant increase in polydrug use and polysubstance-related deaths documented in national surveillance data [7, ix, 23, 25, 26]. Every bit noted previously, nearly all of our respondents as well used some class of opioids, though their descriptions of methamphetamine overdoses did non announced to exist related to opioids. Because many methamphetamine-related deaths may be more than accurately attributed to polysubstance use (including combination of methamphetamine and opioids), structural intervention strategies that have been deployed to address the opioid overdose death crisis could be extended to create safer conditions for methamphetamine consumption. For instance, overdose prevention sites (aka supervised drug consumption/injection sites) have effectively decreased opioid overdose mortality and other health consequences of injecting drug employ in countries outside the USA [54,55,56,57]. Future research efforts should consider how these sites may do good people who employ non-opioid substances (alone or in combination with opioids) including methamphetamines and psychostimulants, both in terms of reducing mortality in the event of an overdose, and in terms of providing support and care for people experiencing unpleasant psychiatric or physical symptoms.

Drug testing programs and safe supply initiatives are other structural interventions that may possibly create safer weather condition for methamphetamine consumption. Drug testing programs include models such as distribution of fentanyl test strips to PWUDs who use opioids, or onsite testing services using either rapid testing devices or mass spectrometry. Drug testing is viable and adequate, and allows PWUDs to test their own drugs and make informed decisions prior to using [58, 59]. Nevertheless, fentanyl exam strips can provide false positives when testing methamphetamine and in the presence of some adulterants [threescore], limiting their utility for PWUDs who use primarily methamphetamine or combine methamphetamine with opioids. Despite widespread business concern about fentanyl-contaminated methamphetamine, the prevalence of fentanyl-positive methamphetamine samples tested with more accurate methods appears to be depression. Data from the National Forensic Laboratory Information System reflects only 0.ane% (northward = 272) of methamphetamine seized in the USA during 2016 contained fentanyl [61]. One study of samples collected between 2017 and 2018 at a supervised drug consumption site in Vancouver, BC, plant that 5.9% (n = xv) of methamphetamine samples independent fentanyl, using a FTRI spectrometer [62]. This highlights the need for accurate testing devices that can exist used in existent time by people who apply methamphetamine. Some research suggests that drug checking programs may be less effective for the most vulnerable or marginalized PWUDs who cannot afford to supplant tainted supplies [63,64,65,66,67]. Therefore, safer supply initiatives, which provide substances of known quality and dosage, should be evaluated for their effectiveness at reducing methamphetamine-related harms.

Another challenge related to the current wave of methamphetamine-related deaths is that medications to care for methamphetamine utilize disorder (especially among people with opioid apply disorder) are however under development in the clinical trial pipeline [68]. Behavioral interventions such as contingency management and cognitive behavioral therapy show some promise merely concerns nearly their durability and sustainability remain [69,lxx,71,72,73,74]. Therefore, there is an urgent need for expanded options for those desiring handling for methamphetamine use disorder. Efforts to extend this knowledge base should be prioritized in the short-term.

Our findings should be interpreted in terms of some limitations. We employed a convenience sampling approach that included street- and agency-based outreach in communities with high volumes of people experiencing homelessness. While our sample showed multifariousness on of import structural determinants of health such equally housing and employment, our findings may not generalize to other communities or methamphetamine-using populations that are less accessible through these sampling methods, such as people with more stable housing. Our sample was also drawn from two Western Us states with high rates of methamphetamine and opioid overdose-related deaths, and correspond a combination of rural, urban, and urban-serving communities. However, important cultural and structural differences may limit the generalizability of our findings beyond these communities. Considering our qualitative interviews sought to understand participants' patterns of substance utilise (including polysubstance use and changes over time) and their personal experiences of and understanding about overdose, our findings should not be used to draw conclusions about the particular routes of administration, substances used, or combinations thereof that elevate or reduce risk of overdose. Chiefly, while we did ask respondents specifically about witnessing fatal methamphetamine overdoses, few were described, and our conclusions are largely express to non-fatal events.

Determination

The Us is in the midst of a "fourth wave" of overdose deaths, increasingly attributed to methamphetamine used alone or in combination with opioids. When asked directly about their experiences of methamphetamine overdose, our respondents claimed that astute, fatal overdose is rare or fifty-fifty impossible. However, they did describe a number of undesirable symptoms associated with overconsumption of methamphetamine and had few clinical or harm reduction strategies at their disposal to reduce those undesirable furnishings. Addressing this current wave of drug-related deaths will crave attention to the multi-level factors that structure experiences of methamphetamine "overdose," and a collaborative try with PWUDs to devise effective harm reduction and treatment strategies.

Availability of data and materials

Because of the sensitive nature of the information independent in the transcripts (east.g., details near illegal behavior) and potential for astringent ethical, legal, and social consequences resulting from cleaved confidentiality, full transcripts volition not be fabricated publicly bachelor. Redacted excerpts of the qualitative transcripts used in the current assay will be fabricated available to qualified researchers subject to review and approval by the advisable Institutional Review Lath(s). Requests can be made to the University of Nevada, Reno Inquiry Integrity Part by calling + 1-775-327-2368.

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Acknowledgements

The authors would similar to acknowledge Birgitta Bisztray, Brittany Rhed, Louisiana Sanchez, & Nathan Leach for their contributions to the data collection and design of this study. Additionally, we would like to thank The Mount Center, & the Reno Initiative for Shelter & Equality for the work they do every solar day to reduce harms in our community, and for their on-going partnership and collaboration with the enquiry team.

Funding

The authors would like to thank the Clinical Translational Research Infrastructure Network for the funding that fabricated this piece of work possible (5U54GM104944-07).

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Affiliations

  1. School of Public Health, University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno, NV, 89509, United states

    Robert West. Harding, Krysti P. Smith & Karla D. Wagner

  2. University of New Mexico Wellness Sciences Center, Albuquerque, NM, USA

    Katherine T. Wagner & Kimberly Page

  3. The Mountain Heart Impairment Reduction Center, Santa Fe, NM, USA

    Phillip Fiuty

Contributions

RWH involved in conceptualization, data curation, formal analysis, investigation, project administration, supervision, writing—original typhoon/review and editing. KTW took office in conceptualization, data curation, project assistants, supervision, validation, writing—review and editing. PH involved in conceptualization, methodology, resource, supervision, validation. KPS took part in conceptualization, data curation, project administration, supervision. KP involved in conceptualization, funding conquering, methodology, supervision, validation, writing—review and editing. KDW took part in conceptualization, funding acquisition, investigation, methodology, supervision, validation, writing—original draft/review and editing. All authors read and approved the last manuscript.

Corresponding author

Correspondence to Karla D. Wagner.

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Harding, R.W., Wagner, 1000.T., Fiuty, P. et al. "It'due south called overamping": experiences of overdose amidst people who use methamphetamine. Damage Reduct J xix, iv (2022). https://doi.org/10.1186/s12954-022-00588-7

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Keywords

  • Methamphetamine
  • Overdose
  • Polysubstance utilize
  • Qualitative methods

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