Emergency Room Utilization and Methamphetamine Overdose Symptoms Among Syringe Service Program Clients in Washington State

Background: Methamphetamine overdose, also known as overamping or acute methamphetamine toxicity, can cause severe psychological and physical health issues including psychosis, heart attack, and death. People who use methamphetamine (PWUM) who experience methamphetamine overdose symptoms (MOS) are advised to seek emergency healthcare, however the factors related to seeking this care are not well characterized. MethodsThis study used data from the 2021 Washington State Syringe Service Program Survey, a cross sectional survey administered to syringe service program (SSP) clients at 21 participating SSP’s in Washington state. Respondents answered questions related to substance use including ER utilization for methamphetamine and whether they experienced psychological and physical MOS. We assessed the association between ER utilization for methamphetamine, non-fatal opioid overdose, and other key covariates among PWUM who experienced MOS using Poisson regression to calculate crude and adjusted prevalence ratios. We also tested if rurality or housing status modified the relationship between opioid overdose and ER utilization for methamphetamine. ResultsMethamphetamine use in the last 3 months was reported by 822 (86%) of 955 respondents. Among PWUM, 31% reported psychological MOS, 19% reported physical MOS, and 37% reported at least one MOS. In the regression analysis we found that non-fatal opioid overdose (APR: 2.04, 95% CI 1.38-3.03), main drug of goofballs (APR: 1.92, 95% CI: 1.38-2.67) and recent blood infection/sepsis (APR: 2.07, 95% CI: 1.24-3.46) were associated with ER utilization for methamphetamine among PWUM who experienced MOS. We found no evidence that rurality or housing status modified the association between opioid overdose and ER utilization for methamphetamine. ConclusionAmong PWID in Washington state, methamphetamine use remains high, and MOS are common. Recent non-fatal opioid overdose was associated with higher rates of ER utilization for methamphetamine among people who experienced MOS, suggesting patients in the ER for MOS should also be screened for opioid use disorder and linked with harm reduction supplies like Naloxone and medications for opioid use disorder (MOUD) like Methadone and Buprenorphine.