Stimulant-Involved Deaths in the US

"Teaching persons who use drugs and their family and friends, as well as medical professionals, how to identify symptoms of stimulant overdoses (e.g., CVD [Cardiovascular Disease] events or psychosis) might improve response timeliness and save lives. Unlike opioids, no stimulant overdose reversal agents or approved medication-based treatments for stimulant use disorder exist (3). Contingency management, a behavioral intervention that positively reinforces recovery-related behaviors (e.g., abstinence), is the most effective treatment for stimulant use disorder but remains underused**** (4). Low-barrier care models and improved linkage to care (e.g., during ED visits for nonfatal overdoses involving stimulants) might increase treatment uptake and retention.††††

"Seventy three percent of stimulant-involved overdose deaths co-involved opioids, representing almost 45% of all overdose deaths. Drug-checking programs rarely detected opioids in recent stimulant products, suggesting that persons who died of overdoses involving both stimulants and opioids intentionally co-used separate stimulant and opioid products (6,7). Reasons persons have reported for co-using opioids and stimulants include reducing opioid withdrawal symptoms and balancing the sedating effects of opioids; despite perceived benefits, co-use can increase overdose risk (3). In the event of an overdose, opioid reversal agents do not reverse stimulant effects; therefore, additional treatment of stimulant effects (e.g., treatment for agitation or seizures and implementation of cooling strategies) might be needed when opioids and stimulants are used together (3). In addition, stimulant use complicates opioid use disorder (OUD) treatment, and guidance is limited for treating co-occurring stimulant use disorder and OUD (4). Coordinated, evidence-based treatments for co-occurring use disorders are urgently needed. Provisional data indicating declines in overdose deaths in 2024 primarily reflect decreases in deaths involving synthetic opioids such as illegally manufactured fentanyls (IMFs) (8); challenges treating co-occurring stimulant use disorder and OUD might attenuate declines.

"Approximately 50,000 (15%) overdose deaths during 3.5 years involved stimulants and no opioids. Nearly 40% had a CVD history, possibly representing long-term stimulant use (4). Persons who use stimulants but not opioids have limited tailored interventions and treatments available to prevent death and support recovery and might be missed by existing opioid-focused prevention efforts. Including stimulant-specific guidance in risk reduction strategies and improving access to and retention in treatment for stimulant use disorder might reduce overdose deaths. In addition, persons who died of overdoses involving stimulants and no opioids were older and less often had an opioid use history than those who died of overdoses co-involving stimulants and opioids; overdose prevention and response efforts might therefore require different outreach strategies to reach this population."