The Increase in Methamphetamine-Induced Psychotic Disorder Emergency Department Visits in the Wake of Kentucky’s Opioid Epidemic

While the majority of nonfatal drug overdoses presenting at Kentucky emergency departments (EDs) continue to involve at least one type of opioid, stimulant involvement has increased 27% from 518 nonfatal overdoses in 2016 to 658 nonfatal overdoses in 2020. Stimulant use and stimulant use disorders (SUD) are also growing problems in the Commonwealth as evidenced by the rise in ED encounters involving SUD and stimulant-induced psychotic disorder (SIPD). In the first quarter of 2016, 47 people presenting at Kentucky EDs received a diagnosis of SIPD with 264 diagnoses of other types of stimulant use disorders or intoxication. In the third quarter of 2021, 212 ED patients were diagnosed with SIPD, an increase of 351%, and 560 patients were diagnosed with other types of stimulant-use disorder or intoxication, an increase of 112%. This rise has not been evenly distributed among residents of the Commonwealth. White ED patients were diagnosed with SIPD at a rate of 6.9 encounters per 100,000 white residents in 2017 (95% CI 6.1–7.7) and 16.2 encounters per 100,000 white residents in 2020 (95% CI 14.9–17.5). In contrast, black ED patients received the same diagnosis at a rate of 9.1 encounters per 100,000 black residents in 2017 (95% CI 6.0–12.2) and 25.1 encounters per 100,00 black residents in 2020 (95% CI 19.9–30.2). This presentation assesses race-based and geography-based differences in the rise of stimulant-involved overdoses, SUD, and SIPD and disparities in their diagnoses. It also discusses the clinical implications of these trends including the expansion of treatment for co-morbid SUD and severe mental illness, the trainings available to first responders, and the development of a tool to help providers connect patients with treatment services.