Bexar County reached a historically high number of drug-overdose deaths in 2023, with 509, according to a Public Health Watch analysis of provisional federal data. Three hundred twenty-seven of those deaths involved methamphetamine — also an all-time high — according to the data, compiled by the Centers for Disease Control and Prevention. There were 498 overdose deaths in 2022.
The city of San Antonio’s Metropolitan Health District intends to declare local overdoses a public health emergency, Jessie Higgins, the city’s chief mental health officer, said during a community meeting last month. Such a designation is mainly symbolic, though it could build public awareness and help activists with their fundraising efforts.
“Overdose deaths are rising and stimulants pose a huge risk for our community,” Higgins said.
While deaths related to some common opioids, like heroin, fentanyl and tramadol, decreased 10% in Bexar County between 2022 and 2023, methamphetamine-related overdoses were up just over 1%. They were 53% higher than they were as recently as 2020.
Experts believe several factors explain the spike. Methamphetamine deaths were already increasing in the United States, and the despair and boredom that came with the pandemic accelerated the trend, said Chukwuemeka Okafor, an epidemiology professor at UT Health San Antonio.
“Many people were at home. Facilities for substance use were disrupted. There was despair,” Okafor said.
What’s happening with methamphetamine in San Antonio is part of a national trend, said Jennifer Sharpe Potter, a professor of psychiatry at UT Health San Antonio and the director of Be Well Institute on Substance Use and Related Disorders.
CDC data show that there were 104,302 overdose deaths from all drugs in the United States in 2023, down 2% from 106,472 in 2022. There were 38,401 and 37,189 methamphetamine-related deaths, respectively, in those years.
According to the National Institute of Drug Abuse, the number of frequent methamphetamine users in the U.S. — defined as those who use the drug at least 100 days a year — increased 66% from 2015 to 2019.
Methamphetamine deaths are harder to prevent than those involving other drugs because there’s no obvious antidote like naloxone, used by first responders to treat opioid overdoses.
Opioids and methamphetamine behave very differently in the body, said Brett Ginsburg, a psychiatry professor at UT Health San Antonio. The former target opioid receptors in the brain, blocking pain and releasing dopamine, a hormone that creates feelings of pleasure and satisfaction. In the process, they interfere with the part of the brain that regulates breathing. Naloxone works by blocking opioid receptors and restoring respiration.
The effect of stimulants like methamphetamine is more like that of a clogged drain, Ginsburg said. The brain has a constant flow of dopamine and other hormones as part of its normal activity. “Psychostimulants work by blocking the drain in the sink. Your sink fills up. Your brain fills up with dopamine or serotonin or epinephrine,” he said. “The only way to change that is really to unclog the drain.” There is no medication capable of doing that, though scientists are working to develop one.
If people consume more methamphetamine than their bodies can handle, they can suffer a heart attack, stroke, overheating or organ failure. Chronic drug use also takes a toll on the cardiovascular system.
“If someone's going into cardiac arrest because of a psychostimulant, like methamphetamine, well, that's a much harder thing to reverse,” Ginsburg said. Since there is no pharmacological antidote to the drug, paramedics can only focus on getting the heart to work again. The victim may become agitated, even aggressive, further complicating first responders’ task.
Michael Li, a family medicine professor at UCLA who studies methamphetamine use, said research points to a possible solution.
“The way we might be able to intervene in an overdose is to find something that binds to the methamphetamine and pulls it out,” Li said. But such medications are still being tested.
Another challenge: There is no approved treatment for methamphetamine-use disorder. “When somebody presents with an opioid overdose, once you reverse the overdose and stabilize them, you can offer treatment,” Potter said. “The problem with methamphetamine is that we don’t have a lot of evidence-based treatments and certainly not an FDA-approved medication to treat stimulant use disorders.”
A two-medication combination showed promising results, according to a 2021 paper, but that treatment course is not publicly available. Another option is what researchers call “behavioral” or “contingency management” therapy, in which people are paid to stay sober or decrease their drug use.
“It works like magic,” Okafor said. “But it’s controversial and it’s not widespread because of the controversy around it.”
The city of San Antonio plans to spend the $909,000 it received as the first installment of opioid settlement funds — money that pharmaceutical companies paid for their role in the opioid crisis — to increase naloxone availability, build an educational website and expand community outreach efforts, among other things, in 2024 and 2025. Some, but not all, of these actions will benefit methamphetamine users.
The city’s 2024 adopted budget also includes a $330,631 state grant to prevent overdoses from substances including methamphetamine, cocaine and alcohol.
The public emergency declaration, when it comes, won’t automatically trigger the release of additional funds. But it could still be useful.
“The value is really just making sure that the community knows that this is a priority,” Higgins said last month.
Potter said researchers and activists can cite the declaration when seeking grant funding. “Do I wish there were more [public] money? Yes, but I am also practical,” she said.
The city wants to adopt a joint resolution with Bexar County to combat overdoses, which could lead to more funding, but that idea is still under discussion, a county spokesperson told Public Health Watch.