By Oisin Stronach, Paul Dietze, Michael Livingston, Amanda Roxburgh

Background

Over the past two decades methamphetamine-related harms have increased in Australia. Previous analysis of methamphetamine-related deaths has covered limited timeframes, and largely focused on drug-toxicity deaths. This paper examines long-term trends in methamphetamine-related deaths over 20 years, including deaths due to a range of specific causes.

Methods

Descriptive analyses were conducted on Australian methamphetamine-related deaths (2001–2023) by cause, extracted from the National Coronial Information System, an online database containing deaths reported to coroners in Australia and New Zealand. Joinpoint trend analyses were used to assess changes over time between 2001 and 2020 (with data from 2021 to 2023 likely incomplete and thus excluded).

Results

Unintentional drug toxicity was the cause of 49.8 % of methamphetamine-related deaths, intentional self-harm (including toxicity) 23.3 %, unintentional injury 15.1 %, natural causes 9.6 %, and assaults 2.3 %. Between 2001 and 2020, joinpoint analysis showed three trend change points among all-cause methamphetamine-related mortality rates, resulting in four distinct periods: two periods where they increased (2001–2006 – annual percentage change (APC) = 15.4 %; 2009–2016 – APC 25.5 %), and two where they decreased (2006–2009 – APC = –11.8 %; 2017–2020 – APC = –2.9 %). Similar patterns were evident among rates of intentional self-harm and unintentional injury. Deaths caused by unintentional drug toxicity saw two trend change points (2011, 2016), and rates increased across all three periods. Natural cause deaths had three trend change points (2007, 2010, 2015), and rates continued to rise after 2015, largely driven by increases in circulatory diseases.

Conclusion

Cause-specific models highlighted diverse trends. Recent trends show unintentional drug toxicity deaths have slightly increased, intentional self-harm stabilised, and unintentional injury and assault deaths have declined. Deaths from natural causes involving methamphetamine continued to increase, highlighting a public health concern and a potential need for early circulatory disease screening among people who use methamphetamine.

International Journal of Drug Policy Volume 131, September 2024, 104548  

By The United Nations Office on Drugs and Crime (UNODC)

Understanding the changing dynamics of heroin and methamphetamine flows from Afghanistan, through southwest Asia to Eastern and Southern Africa, continues to be important, particularly in light of the Taliban’s drug ban in Afghanistan and the harmful effects drugs have on the populations along the route. In order to improve information sharing and to help build connections between countries and International Organisations and to strengthen regional co-operation, UNODC held an Expert Working Group in Maputo, Mozambique during 10th-11th October 2023. Topics discussed at the EWG included an update on the current drug situation in Afghanistan, the opiate and methamphetamine flows from southwest Asia to Eastern and Southern Africa, regional drug seizures, the nature of organized crime groups and a summary of the drug demand situation in the region. The findings of the EWG are published in this report. This EWG report covers the flow and distribution of heroin along the Southern Route, highlighting key trends and vulnerabilities. Exploration of the routes utilized for drug trafficking sheds light on movements from Afghanistan into Eastern and Southern Africa, within Africa, and towards other destination countries. Moreover, an overview of the demand for illicit drugs in the region offers insights into the societal impact and challenges faced by communities. Insight into the fragmented groups and the critical role played by brokers, as well as the strong presence of criminal networks, provides valuable context on the organized crime landscape. Furthermore, the EWG discussed the regional cooperation efforts aimed at addressing drug trafficking challenges and promoting collective action underscores the importance of collaborative approaches in responding to the drug trade in the region. An examination of the policy and law enforcement responses implemented by affected countries provides valuable insights into national efforts to address the supply and demand dynamics. Analysis of the various modus operandi and trafficking methods employed by organized crime groups, including poly drug trafficking and links to other crime types, enhances understanding of the operational tactics used in the region. Finally, recommendations for policy interventions and follow-up actions aim to enhance counter-trafficking efforts and promote regional security and stability. Through a comprehensive examination of these topics, this report seeks to provide valuable insights and inform stakeholders on the complexities of drug trafficking along the Southern Route, with the ultimate goal of fostering effective strategies and initiatives to combat illicit drug trade in the region.   

 Vienna:  UNODC  2024. 36p.

By Jason Beaman

This final research report describes a project that used various data sources to analyze the relationship between methamphetamine usage metrics, such as overdose deaths and related crimes, and violent crime such as rape and robbery, in order to inform law enforcement and other stakeholders of upstream prevention for crimes related to methamphetamine use. The project’s key objectives included developing a dashboard, analyzing methamphetamine-crime intersections, and assessing the influence of social determinants of health (SDOH) of methamphetamine use. Results demonstrated significant correlations between methamphetamine overdoses and violent crimes, especially economic-compulsive crimes. The report highlights distinct patterns and geographic variations among rural and American Indian communities. The report notes that results emphasize the complex interplay between methamphetamine use, violent crime, and socio-economic factors, and it advocates for targeted prevention strategies. It also offers the Oklahoma Methamphetamine Data Initiative (OKMDI) framework for addressing substance use and violence as a tool for policymakers and law enforcement.

Stillwater, OK: Oklahoma State University, 2024. 39p.

By Russ Scott

Australia has one of the highest rates in the world of the use of the crystalline form of methamphetamine, a highly addictive stimulant that is often associated with a chronic, relapsing dependency. Methamphetamine use is associated with both acquisitive and violent offending, which cause substantial personal and societal costs. Whilst the short-term euphoria and stimulation provide a positive reinforcement to methamphetamine use, the aversive states of withdrawing from methamphetamine and the associated craving, which may last up to five weeks into abstinence, underlie the negative reinforcement to continued methamphetamine use. Although many methamphetamine-dependent users experience high levels of psychological distress, it is likely that less than half engage with treatment or support services, and current intervention and treatment programmes have high discontinuation rates. Stigma and discrimination, even from paramedics and health clinicians, are prominent barriers to methamphetamine-dependent users accessing treatment in Australia

Psychiatry, Psychology and Law; Vol. 31, No. 4, 671–704,, 2024

By Jonathan P. Caulkins and Keith Humphreys

If, in 2015, someone had told you that the number of overdose deaths caused solely by the two most historically lethal drugs—heroin and cocaine—would drop by more than half by 2021, you would likely have assumed that the overdose crisis in the U.S. was finally coming to an end. Instead, drug overdose deaths soared to more than 100,000 per year due to the rise of synthetic drugs, a truly disruptive innovation with which U.S. drug policy is only beginning to grapple.

To clarify the key term: synthetic drugs are substances that can be produced in a lab and are not from plant-derived components. In Canadian and U.S. illegal opioid markets, synthetic fentanyl and its analogues are outcompeting heroin, which is made from the poppy plant. These synthetics claimed the lives of more than 70,000 Americans in 2021 (out of 106,699 total drug-involved overdose deaths, or 66%), either by themselves or in combination with other drugs.[1] Methamphetamine, another synthetic, has attained a larger share of the stimulant market than cocaine, which is made from coca leaves.[2] The rapid expansion of synthetic tranquilizers—such as xylazine and benzodiazepines—has spread addiction and death, particularly when these drugs are used in combination with opioids. The U.S. is also facing a bevy of so-called new psychoactive substances (NPS), such as MDMA and mephedrone, that collectively attract more users than do older, “minor” drugs such as LSD, GHB, and PCP.

Drug policy analysts, including the authors of this brief, are swamped with requests from desperate policymakers, clinicians, parents, and activists to find solutions to the problem of synthetic drugs. This brief comprises our answer. Unfortunately, it is not particularly upbeat. All four traditional pillars of drug policy—enforcement, treatment, harm reduction, and prevention—have limits, and there is no simple solution for the synthetic drug market. Nonetheless, the nation can do some things better and should stop doing other things that are harmful. Policymakers must:

• Maintain prohibition of the production and sale of synthetic drugs

• Expect law enforcement to shrink market-related harms, such as violence, but not necessarily to shrink the supply of the drugs themselves

• Keep expanding medication-assisted treatment and access to naloxone

• Embrace the shunning of illegal drugs as a cultural norm

• Be generous toward those who are struggling, including those suffering from drug addiction

Unfortunately, the widespread availability of potentially lethal temptations in the U.S. may be the new normal, and overdose deaths will continue to remain higher than historical norms. Such realism is depressing but honest, and honesty is the best foundation for policy.

New York: Manhattan Institute, 2023. 13p.

By European Monitoring Centre for Drugs and Drug Addiction and Europol

EU Drug Market: Amphetamine describes the European amphetamine market from production and trafficking, to distribution and use. It details the processes, materials and actors involved at different stages and levels of the market. Taking a threat assessment approach, the module identifies key issues and makes recommendations for action at EU and Member State level.

Amphetamine is the most common synthetic stimulant drug available on the European drug market and it competes with cocaine and a range of new psychoactive substances for a share of the profitable European Union (EU) stimulant drug market. The prevalence of amphetamine use is higher than methamphetamine in most EU Member States, with notable exceptions, such as Czechia and Slovakia. Illicit amphetamine products mostly consist of powders or pastes, usually mixed with other ingredients, such as lactose, dextrose or caffeine, but tablets containing amphetamine are also available. The estimated annual value of the retail market for amphetamine in the EU is at least EUR 1.1 billion, with a range of EUR 0.9 billion to EUR 1.4 billion.

The demand for amphetamine in the EU is met by European production concentrated largely in the Netherlands and Belgium, where production is complex, large-scale and based on the drug precursor BMK. BMK has some limited use in industry and can be diverted from legitimate sources or smuggled into the EU, but more frequently it is made from chemicals known as designer precursors imported from China. Some of the amphetamine produced in the EU is used to produce captagon tablets, which are mainly trafficked to consumer markets in the Middle East

Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction and Europol, 2023. 8p.

By Vanda Felbab-Brown

Synthetic opioids remain the source of the deadliest U.S. drug epidemic ever. Since 1999, drug overdoses have killed approximately 1 million Americans,[1] an overdose lethality that has increased significantly since 2012 when synthetic opioids from China began supplying the U.S. demand for illicit opioids. Even though China placed the entire class of fentanyl-type drugs and two key fentanyl precursors under a controlled regulatory regime in May 2019, it remains the principal (if indirect) source of U.S. fentanyl. Fentanyl scheduling and China’s adoption of stricter mail monitoring has created some deterrence effects. Instead of finished fentanyl being shipped directly to the United States, most smuggling now takes place via Mexico. Mexican criminal groups source fentanyl precursors — and increasingly pre-precursors — from China, and then traffic finished fentanyl from Mexico to the United States. Scheduling of fentanyl and its precursors in China is not sufficient to stem flows to the United States.

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  There is little visibility into China’s enforcement of its fentanyl regulations, but it clearly remains limited. U.S.-China counternarcotics cooperation remains fraught, and from the U.S. perspective inadequate. Rejecting U.S. blame of China for the opioid epidemic and emphasizing U.S. responsibilities for that calamity, Beijing points to its benevolence in anti-drug cooperation. But China’s cooperation with the U.S. in the global counternarcotics campaign has been subordinated to the overall deteriorated geostrategic relationship between the two superpowers. There is little prospect that in the absence of significant warming of the overall U.S.-China bilateral relationship, China would significantly intensify its anti-drug cooperation with the United States. U.S. punitive measures, such as sanctions and drug indictments, are unlikely to change that. Structural characteristics of synthetic drugs, including the ease of developing similar, but not scheduled synthetic drugs and their new precursors — increasingly a wide array of dual-use chemicals — pose immense structural obstacles to controlling supply, irrespective of political will to prohibit and regulate their use and enforce the regulations.

New York: Brennan Center for Justice, 2022. 84p.

By Jason Eligh

The purpose of this report is to examine the existing retail markets for meth across several countries in eastern and southern Africa. This will be achieved through an analysis of meth availability, retail meth prices, distribution systems and domestic marketplaces. The report provides an analytical summary of meth markets that is grounded in data collected in 10 countries across the region with details of specific retail price points, commentary on domestic meth distribution systems and structures, and discussion of common structural characteristics across the region that enable and sustain these markets. Furthermore, the data generated from research undertaken for this report is intended to contribute to the broader regional objective of constructing an open-source database of time-series, country-specific illicit commodity price data, where applicable and practicable.

Geneva: Global Initiative Against Transnational Organized Crime, 2020. 104p.