Methamphetamine Use Is Growing Among Fentanyl Users
Synthetic speedballing is now a nationwide problem.
Posted October 29, 2025 | Reviewed by Hara Estroff Marano
Methamphetamine use , methamphetamine-related overdoses, and methamphetamine use disorder (MUD) are national problems that cause serious illness and death.. Making matters worse, methamphetamine is frequently taken along with fentanyl. Speedballing (using an opioid depressant with a psychostimulant) is an everyday reality. From January 2021 to June 2024, nearly a third (31.2%) of all overdose deaths involved methamphetamine, and almost three-quarters (73.0%) co-involved opioids. A recent JAMA article describes users, medical consequences, and treatment approaches.
Stimulants like amphetamines and methamphetamines emerged in the early 20th century for military use in World War II and were subsequently prescribed to civilians, as well as being diverted and misused. By the late 1960s–1970s, large-scale cross-border production surged. Today, methamphetamine is highly pure, made in clandestine labs, and trafficked by transnational organizations.
Data from the Centers for Disease Control and Prevention (CDC) indicate that nearly 60% of fatal fentanyl overdoses in 2023 involved stimulants. Clinically, this means that first responders, emergency departments, and treatment encounters usually have to contend with mixed, multiple drugs, rarely single agents.
The Drug Enforcement Administration (DEA) warns "one pill can kill," and counterfeit pills with both fentanyl and methamphetamine flood markets in the United States, often sold via social media or messaging apps. DEA reporting and independent drug-checking studies indicate that high-purity methamphetamine is widely available, cheap, and increasingly doctored with fentanyl. Consequently, when patients report using methamphetamine or fentanyl alone, polysubstance risk should be considered, unless proven otherwise. Even if the patient reports “just meth,” medical staff should err on the side of administering naloxone (Narcan), because fentanyl contamination is so common.
Why Do Opioid Epidemics Always End with Psychostimulants?
David Musto, M.D., the late Yale University School of Medicine professor, colleague, and foremost historian of American drug policy, observed recurring cycles in U.S. drug epidemics based on historical patterns dating back to the late 19th century. Opioid epidemics, characterized by widespread addiction to depressants like morphine, heroin, and opium, tend to peak amid growing social alarm over dependency, crime , and health issues. Cocaine epidemics emerge because they offer a compelling and energizing high, and are perceived as less physically debilitating than opioids, appealing to recreational users and those seeking competitiveness, aggressiveness, and alertness amid economic or cultural changes.
Musto hypothesized that the switch from opioids to psychostimulants reflects generational amnesia. The new generation forgets the lessons from the prior epidemic. Musto emphasized that the waves are not random but tied to cultural anxieties, supply shifts, and policy focus moving from one threat to another.
What Does Science Say
When lab animals self-administer opioids (heroin, morphine, or fentanyl), they develop a strong dopamine release in the brain’s nucleus accumbens. Later introduction of a psychostimulant like methamphetamine/cocaine engages similar but distinct circuits. Animals previously exposed to opioids often prefer cocaine/methamphetamine if available, because stimulants produce a stronger, faster dopaminergic release.
Cocaine vs Methamphetamine
Cocaine originates from coca plants native to Colombia, Peru, and Bolivia. The harvested coca is processed into coca paste, refined into cocaine hydrochloride, and trafficked through Central America and Mexico for U.S. customers. That process is land‐ and labor-intensive. In contrast, methamphetamine is easily made in a lab using precursor chemicals like pseudoephedrine. Meth and fentanyl are sent to U.S. markets in smaller shipments, with higher potency per weight, also easier to conceal, and translating into higher profits (less cost, less risk).
The cartels prefer manufacturing synthetic drugs over plant-based drug cultivation and trafficking. Why plant‐based drugs still exist (and persist) is a good question. But, coca and poppy cultivation and cultures are deeply entrenched. Some user populations prefer particular drugs; clubgoers in New York City and Miami prefer cocaine over meth.
Methamphetamine is a potent stimulant that increases the release and inhibits the reuptake of dopamine, norepinephrine, and serotonin, producing euphoria, alertness, decreased appetite , and potent reinforcement. Clinically, use translates into executive dysfunction , mood disturbance, and, for some, vulnerability to persistent or recurrent psychosis .
Preclinical and clinical literature reported by Jean Lud Cadet, M.D., of the National Institute on Drug Abuse and colleagues show that structural and cellular brain injury can occur with chronic methamphetamine exposure.
If people using methamphetamine feel too hot, it’s a medical emergency. Emergency departments have a low threshold for admission to the ICU if severe hyperthermia or organ dysfunction occurs, as extreme heat plus meth can be fatal. Active cooling is performed by applying ice packs to the groin, using fans, and administering cold intravenous fluids. Emergency management involves continuous cardiac and temperature monitoring, described as airway/breathing/circulation (ABC). Benzodiazepine medications may be given for agitation or seizures. Complications include stroke, aortic trauma , and suicide risk, among others.
Meth-intoxicated patients can show jitteriness/palpitations and may have a severe sympathetic surge, with chest pain, arrhythmia, malignant hyperthermia, seizures, and toxic psychosis. After patients are stabilized, standard cardiovascular risk modification and cardiomyopathy/pulmonary hypertension workups are made as indicated. Dental referrals also may be made for severe damage from “meth mouth.”
Patients with psychosis induced by methamphetamine commonly present with persecutory delusions and auditory hallucinations, often with agitation and insomnia . Many cases quickly remit with abstinence in days to weeks, but 15–30% of patients have persistent or recurrent psychosis. Antipsychotics for psychosis are administered once overdose threats are controlled. No antipsychotic appears better than another.
Therapy: Contingency Management (CM) and Cognitive Behavioral Therapy (CBT)
The most direct way to avert recurrent meth psychosis is to prevent meth reuse via evidence-based therapy such as contingency management (CM) and cognitive behavioral therapy (CBT) in an integrated psychiatric -addiction treatment program.
CM treatment gives vouchers or prizes as reinforcement, contingent on drug-negative tests or treatment engagement. CM consistently outperforms counseling alone for stimulant use disorders. High-quality evidence supports integrating CM into routine care, with attention to compliance requirements.
CBT remains foundational in craving management, cognitive restructuring, and relapse -prevention skills. UCLA's Matrix Model, developed by my colleague Dr. Richard A. Rawson in the 1980s, integrates CBT with intensive outpatient structure (individual + group, family education , frequent testing) over 16 weeks. Benefits depend on attendance and early abstinence.
Pharmacotherapies: Using Off-Label Options
Some off-label options have proven effective in patients addicted to methamphetamine. One study found that extended-release injectable naltrexone (380 mg q3wk) + extended-release oral bupropion (450 mg/day) significantly increased the proportion of responders, the strongest pharmacologic data.
Long-acting stimulants (e.g., methylphenidate SR, lisdexamfetamine) have shown modest reductions in use days but risk diversion and abuse.
Inpatient Residential Treatment
Meth or cocaine binges can be alarming, risky, and dangerous. Inpatient or residential treatment is a common intervention that changes the environment , reduces craving, teaches relapse prevention, and improves loss of control. Recovery is possible with detox, time, individual and group therapy, and AA/NA. Treatment of other disorders is necessary, along with healthy eating, exercise, and support from family, friends, and professionals.
CDC data show that among 309,274 overdose deaths from January 2021 to June 2024 in 49 states and D.C., 59.0% involved any stimulant, 31.2% involved methamphetamine, and 30.0% involved cocaine; 3.8% involved both methamphetamine and cocaine.
Cocaine and meth use among fentanyl users is the new normal. Meth and cocaine are competing for illicit market share just as fentanyl competed with heroin a few years ago. Synthetics have the edge, and the new speedball is a synthetic combo of fentanyl and methamphetamine. There is no single FDA-approved medication for meth use disorder or overdose.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.