The deadly and addictive fentanyl has certainly gained attention when it comes to overdose deaths — but the carnage from stimulants like meth and cocaine is increasing at a much faster rate.
In the span of a single year, heroin-related deaths fell nearly 34% nationally, while deaths from natural and semi-synthetic drugs (morphine, codeine, oxycodone, hydrocodone ) fell by almost 13%. Methadone deaths fell 1.1 percent, according to federal data presented at the recent American Society of Addiction Medicine conference in Dallas.
This is the “good” news, if you will. The bad news includes the fact that deaths linked to synthetic opioids – primarily fentanyl – jumped 5.7% between 2022 and 2023. But deaths linked to methamphetamine jumped even faster – by 6.4%. – while cocaine-related overdoses increased by 12.2%.
In California, this is happening against a backdrop of growing homelessness. Many people on the streets use methamphetamine to stay awake at night and avoid becoming victims of crime, especially women. It’s cheap, easy to get, highly addictive, and creates its own hell.
Chronic methamphetamine users may exhibit violent behavior, anxiety, confusion, insomnia, and psychotic features including paranoia, aggression, visual and auditory hallucinations, disturbances mood and delusions, such as the feeling of insects crawling on or under the skin, according to the Drug Enforcement Agency. .
Deaths linked to psychostimulant use have more than doubled in California in just three years, according to state data.
• In 2019, there were 2,875 deaths related to psychostimulant use in California. This includes 571 in Los Angeles County; 288 in San Diego County; 209 in Riverside County; 153 in Orange County; and 123 in San Bernardino County.
• In 2022, there were 5,833 deaths related to psychostimulant use in California. That includes 1,361 people in Los Angeles County; 588 in San Diego County; 517 in Riverside County; 412 in Orange County; and 197 in San Bernardino County.
While there are good medications to manage opioid use and OK medications to manage alcohol use, there are not yet FDA-approved medications to manage stimulant use disorder .
Medicine?
Currently, treatment is mostly limited to behavioral therapies, said Dr. Madhukar Trivedi, a professor of psychiatry at the University of Texas Medical Center.
But researchers are studying the use of many different medications as interventions for methamphetamine use disorder, including naltrexone and bupropion, as good as the effectiveness and safety of ketamine, which may be useful in treating depression. Buprenorphine, the gold standard of opioid treatment, may also hold promise.
For cocaine, a recent study suggested that genetic variation played a role in how people responded to buprenorphine plus naltrexone during treatment. Trivedi said more work is needed to better understand the body’s mechanisms that could improve drug treatment.
Researchers are also excited about using artificial intelligence to zero in on drugs that could be repurposed for cocaine and methamphetamine treatment. Ketamine has also shown promise in this area, said Rong Xu, a professor at Case Western Reserve University in Ohio.
Pharmaceuticals aren’t everything. One nondrug intervention getting attention is using magnets to stimulate the brain, said Dr. Kathleen T. Brady, a distinguished professor at the Medical University of South Carolina.
Transcranial magnetic stimulation was approved to treat depression in 2008 by the FDA. Although the mechanism is not well understood, studies suggest that it has great potential for the treatment of drug addiction.
All good science raises more questions, researchers say. Relapse is common in addiction treatment – between 40% and 60% – but this is consistent with other chronic illnesses and highlights the importance of medication as a first line of treatment, alongside deep-rooted behavioral changes. It’s not “one or the other.” It’s “and”.
California Daily Newspapers