By Dr. Norman Hoffmann
Before the current health and social crisis, we heard a lot about the opioid epidemic. The opioid epidemic is due in large part to the misuse of prescription pharmaceuticals by physicians. Medical experts have found that even relatively short periods of exposure to narcotic medications could begin the road to addiction for susceptible people. Once addicted, it is not unusual to move to heroin because it is cheaper than the pharmaceuticals. Injection is required for the maximum effect, so overdoses and transmission of infectious diseases have become public health concerns.
As serious as the “opioid epidemic” is, another stimulant epidemic has been rampant in parts of the United States. In 2018, Dr. Dana Hunt presented data from the ADAM (Arrestee Drug Abuse Monitoring) system showing that in California urinalyses of more than half the recent arrestees was positive for methamphetamine. In New York, however, hardly any tested positive for meth. In rural counties, stimulant use disorder is the most prevalent diagnosis. In three out of four counties studied, diagnoses involving meth are more prevalent than opioid diagnoses and always the most prevalent substance use disorder.
In rural counties, stimulant use disorder is the most prevalent diagnosis.
Our own work in North Carolina and Florida uses a detailed diagnostic interview (CAAPE-5: Comprehensive Addiction And Psychological Evaluation – 5) to document substance use disorders based on DSM-5 criteria. About a third of recent arrestees interviewed with the CAAPE-5 report injecting substances to get high. The clear pattern is that both stimulants and opioids are being injected on a regular basis by about one in three persons arrested in rural counties. The clear implication is that widespread use of meth in rural areas rivals or exceeds the magnitude of the opioid problem.
We have also learned that substance misuse and diagnostic patterns can shift markedly over time. For instance, in two adjacent counties, prevalence rates documented in the detailed interviews found that mental health condition rates were almost identical over an eight-year period. In contrast, the rates for substance use disorders varied widely over that time.
We can draw several conclusions from our findings. First, because diagnostic patterns shift over time, monitoring prevalence rates for substance use disorders is an ongoing task. In other words, when you know the prevalence rates of substance use disorders in one location at one point in time, you know the prevalence rates for that location at that point in time. Second, local and ongoing documentation to understand local needs is vital, irrespective of national preoccupation with a given drug category.