PAH cases linked to methamphetamine use surge 93% in 4 years in US: Study
Findings support increased awareness, timely diagnosis and treatment
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The proportion of people in the U.S. with pulmonary arterial hypertension related to the use of methamphetamine (Meth-PAH) increased by 93% between 2018 and 2022, a steeper increase than the one seen for the number of U.S. adults self-reporting methamphetamine use, a new study shows.
The analysis found that Meth-PAH patients were more likely to start treatment with two or three drug class combinations, but were 38% less likely to adhere to medications than patients whose PAH was not linked to methamphetamine use.
“Combined with the low treatment rate of patients with [Meth-PAH] and their higher likelihood of worse disease severity at presentation, our findings support the importance of increased awareness, timely diagnosis and treatment of patients with [Meth-PAH],” researchers wrote.
The study, “Methamphetamine-associated PAH on the Rise in the US: Geographic Trends & Disparities in Patient Demographics and Treatment Strategies,” was published in The Journal of Heart and Lung Transplantation.
Methamphetamine use carries increased risk of PAH
Methamphetamine, colloquially known as meth, is an addictive stimulant whose use has been rising in the U.S. Legally available by prescription to treat attention deficit hyperactivity disorder, methamphetamine has many well-established negative impacts on health, including an increased risk of PAH. People with Meth-PAH have poorer outcomes compared with patients with idiopathic PAH, which means there is no known cause. In addition, meth use creates challenges for care and diagnosis, while also reducing treatment adherence due to stigma, inadequate healthcare access, and other barriers.
PAH is a form of pulmonary hypertension characterized by the narrowing of the pulmonary arteries, blood vessels that transport blood through the lungs, which causes high blood pressure and leads to right heart dysfunction.
In the study, researchers in the U.S. used two databases to analyze 3,590 individuals with Meth-PAH and 52,349 patients whose PAH was not associated with meth use (non-Meth-PAH). All participants received at least one PAH medication between Sept. 2021 and Aug. 2023.
Patients with Meth-PAH tended to be younger (52 years vs. 60 years), with a higher proportion in the 35 to 49 age range (37% vs. 12%), than those with non-Meth-PAH. Geographically, Meth-PAH patients were mainly identified in Western states (65%), while those with non-Meth-PAH were located more in the South (39%).
Most people with Meth-PAH had Medicaid (55%), a program providing medical- and health-related services to low-income individuals. In comparison, the majority of individuals with PAH who didn’t use meth had Medicare (61%), which provides health coverage to older people, as well as younger people with disabilities. Commercial health insurance coverage was similar in the two groups (28% vs. 22%).
Meth-PAH patients 38% less likely to adhere to their medication
Based on 2022 claims data, about 6% of patients with PAH used meth at least once. Between 2018 and 2022, this proportion increased from 4% to 6.4% in the total PAH population in the U.S., but even more so in Western states (12.2% vs. 17.2%). States such as Illinois, Wyoming, and Maine did not experience an increase in the proportion of patients with Meth-PAH among the total patients with PAH, relative to the increase in meth usage by adults.
The number of patients with Meth-PAH increased by 93%, from about 1,400 in 2018 to about 2,700 in 2022. Over the same period, the number of adults in the U.S. reporting meth use increased 55% (from 1.7 million to 2.7 million).
Patients in both groups were more frequently treated with a phosphodiesterase 5 inhibitor (PDE5i) when using a stand-alone therapy. Dual treatment combinations more commonly included a PDE5i and an endothelin receptor antagonist.
Independent of meth use, most participants were initially prescribed stand-alone treatment. However, those with Meth-PAH were more frequently started on dual (29% vs. 19%) or triple (4% vs. 1%) therapy.
This study underscores the urgent need to increase national awareness of [Meth-PAH], establish comprehensive … care pathways from diagnosis to treatment (including provider training in addiction medicine), and develop evidence-based guidelines to address the clinical and societal burden of this growing population.
According to the researchers, these results suggest that people with Meth-PAH receive “a more aggressive initial treatment approach likely driven by more severe disease at presentation or patients being younger and having [fewer coexisting conditions] to be able to withstand dual or triple therapy.”
Regarding treatment adherence, the results showed that Meth-PAH patients were 38% less likely to adhere to their medication than those with non-Meth-PAH. In both groups, adherence to dual therapy was 70% to 72% lower and adherence to triple therapy was 87% to 88% lower than adherence to a single therapy.
“Treatment adherence can reflect the socio-economic status and health literacy of the patient, and this can be different depending on the region being sampled as well as whether the patient is actively using methamphetamine or in recovery,” the researchers noted.
Only 69.4% of people with Meth-PAH in the U.S. received PAH medication in 2022, with higher rates observed in Western states, such as Utah, Oregon, and Washington (82% to 90%). In the Eastern states of New Jersey, Florida, West Virginia, and Michigan, treatment rates were significantly lower than the national average (27% to 43%).
“This study underscores the urgent need to increase national awareness of [Meth-PAH], establish comprehensive … care pathways from diagnosis to treatment (including provider training in addiction medicine), and develop evidence-based guidelines to address the clinical and societal burden of this growing population,” the researchers concluded.
