Unwanted effects, self-management strategies, and consequences of unwanted effects of methamphetamine use

Background Acute methamphetamine toxicities are poorly characterized. We sought to describe unwanted physical and mental effects from methamphetamine use, consequences of unwanted effects (e.g., altercations), and self-management strategies.

We used data from two cross-sectional surveys conducted from 2023 to 2024 in San Francisco and Oakland, CA (N = 1385), of people over 18 years of age who used unregulated drugs. Among participants reporting past 90-day methamphetamine use (n = 955), we determined the proportion with past 90-day unwanted effects; consequences of the most recent episode; and self-management strategies. We conducted bivariate analyses and multiple logistic regression analyses to identify predictors of unwanted effects.

Median age was 43 years, 73% were male, 40% White, 32% Black/African American, 18% Latine, 79% unhoused, with mean 18 of past 30 days methamphetamine use. Nineteen percent reported past 90-day unwanted effects of methamphetamine; independent predictors included Black or Latine race/ethnicity, prior mental health diagnoses, prior involuntary psychiatric hold, more days of methamphetamine use in the past 30 days, and longest stretch of methamphetamine use without sleeping. Among participants reporting unwanted effects, agitation, paranoia, or chest discomfort were most common; 52% reported consequences from unwanted effects, most commonly emergency department admissions; and 89% reported self-management strategies.

Approximately one-fifth of participants regularly reported unwanted methamphetamine effects, associated with race/ethnicity, psychiatric history, and methamphetamine use parameters. Most had self-management strategies, yet more than half reported consequences from unwanted effects, including frequent emergency department admissions. Preventing and managing these toxicities requires distinct strategies compared to other substances like opioids.