Across the United States, methamphetamine use is accelerating at an alarming rate—particularly among people who also use fentanyl. Recent data and clinical observations show that this dangerous combination is reshaping the drug landscape, intensifying overdose risks, and creating new challenges for treatment providers and first responders.
A National Methamphetamine Crisis
Methamphetamine is no longer a regional issue confined to the West Coast. According to national data from January 2021 to June 2024, nearly one-third of all overdose deaths (31.2%) involved methamphetamine. Of those cases, nearly three-quarters (73%) also involved opioids such as fentanyl. This co-involvement underscores how deeply intertwined the two drugs have become.
The New Synthetic “Speedball”
Traditionally, a “speedball” referred to the mixture of cocaine and heroin. Today, an even more dangerous version has emerged: a fully synthetic pairing of methamphetamine—a powerful stimulant—and fentanyl, an ultra-potent opioid.
This combination is readily available, extremely cheap, and often unintentionally consumed, as methamphetamine is frequently contaminated or “doctored” with fentanyl. Because of this, medical responders are now encouraged to administer naloxone even when an individual reports using only meth.
Why This Shift Is Happening
Several factors are driving the rise in methamphetamine use among fentanyl users:
1. Cartel Shift Toward Synthetic Drugs
Drug trafficking organizations increasingly favor synthetic drugs like methamphetamine and fentanyl. These substances don’t rely on plant cultivation, are easier to hide in transport, and offer higher potency and profit margins compared to heroin or cocaine.
2. Historical Drug Cycles
Drug historian David Musto proposed that opioid and stimulant epidemics often alternate across generations. As memories fade and cultural stressors shift, interest in different types of highs resurfaces—creating cyclical patterns of addiction.
3. Neurobiological Factors
Psychostimulants trigger a sharper and faster release of dopamine than opioids do. This intense neurological reward can lead users to gravitate toward methamphetamine as they seek a more energizing and reinforcing high.
Clinical and Emergency Concerns
Methamphetamine use comes with severe mental and physical health consequences:
Mental Health Effects
Methamphetamine use disorder is associated with significant cognitive issues, mood disturbances, and, for 15–30% of users, psychosis involving paranoia or hallucinations.
Medical Emergencies
Chronic meth use can cause lasting brain damage, but its most acute danger is hyperthermia—a dangerous spike in body temperature that requires immediate cooling and cardiac monitoring.
Managing Meth-Induced Psychosis
While psychotic symptoms often improve with abstinence, antipsychotic medications may be used after the person is stabilized and out of immediate overdose risk.
Current Treatment Options for Methamphetamine Use Disorder
There is no FDA-approved medication specifically for treating methamphetamine use disorder or overdose. However, several approaches have shown promise:
Behavioral Treatments
- Contingency Management (CM): Provides rewards for drug-free tests and has repeatedly proven more effective than counseling alone.
- Cognitive Behavioral Therapy (CBT): The Matrix Model, which combines CBT with structured outpatient care, helps manage cravings and reduce relapse risk.
Off-Label Medication Approaches
The most successful pharmacological strategy involves combining extended-release injectable naltrexone with extended-release bupropion, which together may help reduce meth use in certain patients.
Source: Psychology Today – “Methamphetamine Use is Growing Among Fentanyl Users”
https://www.psychologytoday.com/us/blog/addiction-outlook/202510/methamphetamine-use-is-growing-among-fentanyl-users