The latest comprehensive analysis of urine drug test data from Millennium Health suggests that the “stimulant crisis” many experts are predicting might actually be playing out more narrowly as a methamphetamine crisis.
According to the specialty laboratory's analysis of data encompassing drug test results from just over 1 million people between 2013 and last October, positive tests for methamphetamine are continuing to rise rapidly, while cocaine positives recently have been declining after peaking in 2016. Also of particular concern are increasing rates of tests positive for both methamphetamine and fentanyl (co-positives for fentanyl with cocaine are also on the rise).
“We see a clear shift to methamphetamine as the stimulant of choice and fentanyl as the opioid of choice,” Angela Huskey, PharmD, Millennium Health's chief clinical officer, tells Addiction Professional.
The study, published Jan. 3 in JAMA Network Open, found that among fentanyl-positive test results, positivity rates for co-occurring meth rose from 2.2% in 2013 to 11.98% in 2016 to 30.37% in 2019. Meth-positive rates in the overall drug test sample increased from 1.43% in 2013 to 8.39% in 2019, representing more than a 42% increase over that time period. Test results positive for fentanyl increased by more than 75% over the same span.
There are numerous possible explanations for why methamphetamine and fentanyl are being detected together more often, involving both unintentional and intentional use of an opioid with meth. Huskey says clinicians treating substance use disorders should be educating patients who report use of stimulants alone about the risk of opioid overdose.
Providing data to government
Millennium and the U.S. Department of Health and Human Services (HHS) this week each announced a collaboration under which Millennium will regularly provide data from its trademarked Emerging Threat Intelligence Program to inform the government of trends from drug test results obtained from all 50 states and multiple practice types.
Huskey says Millennium recently has invested in additional staff resources to help capture and report on broad trends closer to real time. She adds that the federal government expressed interest in Millennium's work following publication of recent trend reports. Disseminating data from drug testing more quickly should help to uncover use patterns that could predict where overdose death rates may go, she says.
“The donation of this data is critical for reducing the occurrence of the substance use epidemic and reaching the people who need help most,” HHS Assistant Secretary for Health Admiral Brett Giroir, MD, said in the federal agency's news release this week.
The results of Millennium's latest analysis were derived from a sample from all 50 states, with a median age of 45 among the individuals tested. Authors of the report point out that because all of these tests were conducted in health care settings, the results might not be generalizable to the entire U.S. population.