Methamphetamine Use, Mental Health Comorbidities, and Treatment in Rural and Urban Areas

Methamphetamine is a powerful, highly addictive stimulant that can lead to adverse physical and mental health consequences with long-term use. This policy brief examines the urban vs. rural and regional differences in the rates of methamphetamine use, polysubstance use (methamphetamine use with alcohol and opioids), IV methamphetamine use, mental health comorbidities, and receipt of treatment by individuals using methamphetamine, in a representative nationwide sample.

Key Findings:

• About one in twenty (5.5%) respondents reported using methamphetamine in their lifetime. Rates of lifetime use were significantly higher in rural counties (6.8%) compared to urban counties (5.3%).
• Lifetime methamphetamine use was notably high in the rural west, and was highest in rural counties in the Pacific Census Division, where 13.4% of adults reported lifetime methamphetamine use. One in five rural Californians reported lifetime methamphetamine use (21.6%). Rural counties in the Mountain Census Division reported the second highest rates of lifetime methamphetamine use (9.6%).
• Nationally, rates of past year methamphetamine use were higher in rural counties (1.0%) than urban counties (0.6%). Among rural residents, past year methamphetamine use rates were lowest in New England.
• More people in rural counties met the criteria for past year methamphetamine use disorder (MUD) than people in urban counties (0.6% urban vs. 0.3% rural). Large metro urban counties had the lowest overall rates of past year MUD overall (0.6%).
• There is evidence to suggest that people in rural areas partake in riskier methamphetamine use behaviors, such as injecting methamphetamine with a needle and co-using methamphetamine with alcohol, than people in urban areas. Overall, 13.5% of respondents who reported lifetime methamphetamine use reported injecting the drug with a needle. Rates were higher in rural counties (16.6%) than urban counties (12.8%).
• Nationally, rates of past year mental illness and thoughts, plans, or attempts of suicide were high in people who reported using methamphetamine. Over half (59.1%) reported past year mental illness along with a major depressive episode, and seven in ten people (69.1%) with MUD reported past year mental illness and a major depressive episode. Nearly one-quarter of people (23.9%) who reported past year methamphetamine use or past year MUD (28.8%) reported thoughts, plans, or attempts of suicide.
• Thirteen percent of people in rural counties who received substance use treatment in the past year were treated for MUD, compared to 8.2% of people in urban counties.
• One-fourth of people in rural counties (26.0%) who received treatment at a specialty facility in the past year were treated for MUD, compared to less than one-fifth of people in urban counties (17.0%).