REVIEW OF: Daniulaityte R et al, Int J Drug Policy 2022;99:103463

STUDY TYPE: Cross-sectional study

Has a patient ever told you that methamphetamines can be used instead of naloxone to reverse an opioid overdose? We’ve all heard the myth, but it’s unknown how widespread this belief actually is. Rigorous research is lacking, but there are two reasons why this practice could be dangerous. First, opioid overdoses are lethal because of hypoxia caused by respiratory cessation; as a vasoconstrictor, stimulants could compound hypoxia by restricting the flow of already oxygen-poor blood to vital organs. Second, fentanyl is commonly mixed with illicit drugs, so someone administering methamphetamines to reverse an overdose might inadvertently be giving additional fentanyl.

To answer the question of how widespread this belief is, and whether it is actually practiced, researchers conducted a qualitative study to understand lay knowledge, attitudes, and behaviors related to methamphetamines and opioids. Structured interviews and urine toxicology were conducted with 41 individuals (mean age 38.3 years, 51% female, 100% non-Hispanic White) in Ohio who reported past 30-day use of methamphetamine and heroin/fentanyl.

Participants described an unpredictable local opioid market saturated by fentanyl and its derivatives, thus substantially increasing overdose risk. Urine toxicology verified their perceptions; all samples were positive for fentanyl, and many were positive for other various fentanyl analogues such as acetyl fentanyl (61.0%), tetrahydrofuran fentanyl (29.3%), and the highly potent carfentanil (12.2%).

Misconceptions about the utility of methamphetamines in opioid overdose were widespread and commonly practiced. Fifty-four percent believed methamphetamines could reduce the risk of overdose, and 60% thought it could reverse an overdose that was already occurring. Nearly half (46%) had personally used methamphetamines either to manage overdose risk or as an alternative to naloxone. Anecdotally, some participants reported success with this strategy, though it’s unknown if they witnessed an actual overdose reversal.

This study gives a distressing glimpse into the current state of the opioid epidemic, albeit through the lens of a relatively small sample size in a particular geographic area. Most importantly, it shows that people believe that stimulants can mitigate or reverse opioid overdoses. These findings emphasize the importance of gauging your patients’ knowledge about overdose reversal; don’t assume that they know not to administer a stimulant or that they know about naloxone. Educate them on the dangers of combining drugs, explain proper overdose reversal techniques, and ensure they leave your appointment with a naloxone prescription.

CARLAT TAKE

The illicit opioid supply is full of dangerous fentanyl and highly potent fentanyl analogues. The misconception that methamphetamines can be used to treat opioid overdoses is widespread. Be sure to educate patients about the dangers of this practice and ensure that they leave your appointment with naloxone and an understanding of how to use it.