A new study indicates that methamphetamine mortality has increased across every United States census division over a 19-year period. Researchers Andrew Yockey and Rachel Hoopsick said co-involvement of methamphetamine with synthetic opioids could be driving the increases. Graphic by John McCustion/University Marketing and Communications
Rise in meth mortality contributes to fourth wave of overdose epidemic
by Clara Turnage
Once considered a regional problem, methamphetamine-related overdose deaths have risen across every US Census division, with particularly sharp spikes in the Southeast, including Mississippi, a new study reveals.
Andrew Yockey, a University of Mississippi assistant professor of public health, and Rachel Hoopsick, assistant professor of health and kinesiology at the University of Illinois at Urbana-Champaign, studied 19 years of CDC WONDER data to understand the fourth wave of the U.S. overdose epidemic. They published their findings in the Journal of Addiction Medicine.
“Overdose deaths involving stimulants, mostly methamphetamine, have surged over the past two decades,” Yockey said. “Between 1999 and 2023, methamphetamine‑involved deaths increased from 547 to 34,855 annually.”
In 2025, Yockey and Hoopsick reported that methamphetamine-related deaths in the United States rose more than 61-fold between 1999 and 2021. Their latest study shows where those increases happened.
“If we know which areas are seeing more meth-related deaths, we can send help where it’s needed most,” Hoopsick said. “That could mean opening more treatment programs, training health care providers or making sure harm-reduction services, like syringe programs and naloxone distribution, are available in the hardest-hit communities.”
The highest mortality rates were charted in the Pacific and Mountain regions – including states such as Arizona, Alaska, California, Colorado, Idaho, New Mexico, Montana, and Utah – and in the East South Central division, which includes Mississippi, Alabama, Kentucky, and Tennessee.
The US overdose epidemic has moved across the country in three distinct “waves” over the past 25 years, the researchers said.
“Some experts describe the overdose crisis as moving in waves: first prescription opioids, then heroin, then fentanyl,” Hoopsick said. “The fourth wave is marked by overdoses involving both opioids and stimulants like meth.
“Our study shows that meth deaths are rising across every region, and we know from our other research that many involve fentanyl at the same time. This combination has made the crisis more dangerous and more complex.”
The increase in deaths is likely because of the rise of synthetic opioids such as fentanyl, which are easy to create and often deadly when used with methamphetamine. From January 2021 to June 2024 in the United States, 59% of overdose deaths involved stimulants, and 43% of all overdose deaths co‑involved stimulants and opioids.
“Mixing a powerful stimulant like methamphetamine with a potent opioid like fentanyl creates unpredictable and compounding effects,” Yockey said. “The stimulant can mask sedation or respiratory depression, increasing the risk of overdose and increasing the risk of death.”
Understanding the prevalence of methamphetamine overdose can help health care workers in affected areas, the Ole Miss researcher said. Other steps, including expanding harm reduction services and improving access to addiction treatments, could reduce the number of future deaths.
“Knowing where methamphetamine-related deaths are concentrated allows health care workers to prioritize treatment and outreach, helps policymakers allocate funding and craft targeted interventions, and enables community members to engage in prevention efforts and support at-risk populations effectively,” he said.
In some divisions, these strategies may have already shown progress. Despite the overall increase, some states have leveled out or decreased methamphetamine-related mortality between 2020 and 2023.
These divisions – New England and the Middle Atlantic – implemented harm reduction strategies and public health interventions, and that could be contributing to their recent successes.
“‘Leveling off’ doesn’t mean the crisis is over; it means deaths have stopped climbing, but they’re still very high,” Hoopsick said. “It’s possible that harm-reduction efforts and public health programs are helping slow the increase.
“But we shouldn’t take this as a sign to relax.”
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