Overdose deaths involving methamphetamine have increased sharply in Pennsylvania and New Jersey, where a sevenfold rise in death rates between 2015 and 2019 was the highest in the country, a recent analysis from the Pew Charitable Trust found.
The deaths come as more people are using a drug most commonly known as meth, a stimulant which produces an energizing high by increasing activity in the central nervous system.
Hundreds of thousands more adults nationwide reported using meth in 2019 than in 2015, a rise of about 22%, the Pew report found. It’s still less popular than opioids like prescription opioid painkillers, heroin or fentanyl, which have the opposite effect, depressing the central nervous system, relaxing the body and and reducing pain.
Meth has been around for decades, and was once primarily associated with rural areas. Now, it’s being used in widely varying circles, from people using it to enhance sex in party settings to people in opioid addiction in Philadelphia, some of whom use it to combat the sedative-like effects of their drug of choice.
The spike in meth-related deaths, nationwide and locally, is partially because of people using meth and opioids together, intentionally or not. It’s a mark, local experts say, of changing trends in drug markets and drug use in the region — and a reminder that outreach efforts toward people with addiction can’t solely focus on opioids.
Pew analyzed data from the Centers for Disease Control and Prevention that showed a 170% increase in the number of meth-related overdose deaths nationwide between 2015 and 2019.
In New Jersey, the death rate from meth overdoses soared by 733%. Pennsylvania’s death rate jumped by 533%.
More recently, the problem has worsened in Philadelphia, city health officials said, with overdose deaths involving meth rising about 20% between 2020 and 2021.
“It’s gone far and wide and all across the city,” said Jen Shinefeld, a field epidemiologist with the city health department.
She said people who typically use opioids may be turning to meth because of its low price and long-lasting high — and as a way to stay safe.
“People will be up for four to five days, but they feel safer because they’re awake,” she said.
In Philadelphia, meth was previously used mostly as a party drug among men who have sex with men, Shinefeld said. The usage is now much more widespread.
“Meth is becoming the drug of choice in our rural counties, which creates a whole different set of challenges when the treatment system is focused on opioids,” said Jamie Drake, the executive director of the Carbon Monroe Pike Drug and Alcohol Commission, which handles addiction treatment in three rural Pennsylvania counties.
In New Jersey, an advocate working closely with people in addiction in Asbury Park has observed that most of his clients who use meth are part of the LGBTQ community there, using it largely in a party context. The drug is also popular in rural areas, said Bobby Lowry, who works at the Prevention Resource Network, a harm reduction center in Asbury Park.
Rising meth deaths are a crucial reminder that, to combat the overdose crisis, policy makers and advocates must work to offer better options for treatment and to reduce the harmful effects of drug use to people who use drugs other than opioids, which are still responsible for the majority of overdose deaths locally and nationwide, local experts said.
Meth users have limited treatment options in Pennsylvania and New Jersey.
In New Jersey, a handful of 12-step meetings are available for people who use crystal meth, according to Bobby Lowry, who works at the Prevention Resource Network, a harm reduction center in Asbury Park.
“When it comes to anything related to substance use, the majority of the attention goes to opioids,” he said.
In Pennsylvania, health officials say, it is hard for people addicted to stimulants to find effective treatment. There are no FDA-approved medications to treat stimulant use, and funding is slim for a treatment program that’s shown success in treating stimulant addictions by giving people in addiction rewards for changing their behavior.
Meth contaminated with fentanyl is only part of the problem — meth users are at greater risk for long-term health issues, such as brain damage and dental problems, and many lack adequate access to needed health care, Lowry said.
Many people who die from overdoses with meth in their systems are also found to have used fentanyl, a synthetic opioid much more potent than heroin. In 2015, 7% of meth overdoses nationwide also involved fentanyl; by 2019, just under a third of meth overdose victims had also taken fentanyl.
The share of all meth-related overdose deaths involving fentanyl more than quadrupled during this period, from 7% to 31%.
Pennsylvania health officials believe that the use of multiple drugs at the same time, intentionally or not, is likely driving overdose deaths among cocaine and meth users, said Jennifer Smith, the secretary for Pennsylvania’s Department of Drug and Alcohol Programs. (New Jersey health officials did not return a request for comment.)
In Philadelphia, just under half of the fatal overdoses between 2017 and 2020 involved a stimulant, like methamphetamine, and an opioid, like fentanyl.
Fentanyl is driving many deaths that involve stimulants, officials say. In 2020, 568 of the 1,214 people who died of an overdose death had used a stimulant and an opioid. Just 146 of the year’s overdose deaths involved only a stimulant.
While opioids kill by repressing breathing, overdosing on stimulants like meth can involve a constellation of psychological and physical symptoms, like intense paranoia or a racing heartbeat. Those cardiovascular symptoms can be fatal, especially for people with pre-existing health conditions.
It’s sometimes unclear whether overdose victims who died with meth and fentanyl in their systems knew they were taking both drugs. Anecdotally, Pennsylvania’s office on drug programs has fielded reports of meth users who were unaware that their drugs had been cross-contaminated with fentanyl.
In Philadelphia, health officials say, the meth on offer is particularly pure, with almost no additives — so it’s likely that some overdose victims may be intentionally combining meth and fentanyl.
Large supplies of meth started showing up in the city’s drug markets around 2019, with some dealers offering meth alongside fentanyl to opioid users, Shinefeld said.
City officials are working to increase outreach to Philadelphia’s meth users, as well as to develop practices for testing drugs for fentanyl and helping meth users who inject their drugs to avoid common side effects of injection drug use, like lesions and missed veins.
Philadelphia is among the major cities in Pennsylvania that allow syringe exchanges to help reduce the harm from drug use and the distribution of fentanyl testing strips. But both practices are still technically illegal in the state, leaving rural drug users with even fewer options for preventing overdoses, noted Drake, the advocate working with rural counties.
