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Publication Briefs

Death from Overdose Involving Stimulants Increasing in Veterans

Fatal drug overdose continues to be the leading cause of accidental death in the United States. Opioids have been a key focus of overdose prevention and treatment efforts, but recent trends also show stark increases in stimulant-involved overdoses. In 2020, the CDC issued a Health Alert about an acceleration in stimulant-related overdoses (with and without opioids). However, little is known about characteristics of people dying from recent stimulant overdose. Linking data from the National Death Index and VHA, this retrospective cohort study sought to describe trends in stimulant-alone and stimulant and other substance use overdose deaths among Veterans from 2012 to 2018 – and to measure patient and treatment use characteristics across stimulant-related overdose death profiles.


  • The rate of deaths among Veterans from stimulant-related overdose, alone and in combination with other substances, tripled from 2012 to 2018 with the greatest increase in cocaine + opioid-related overdoses (4 times higher in 2018 than 2012). During this time, 3,631 Veterans died from stimulant-involved overdoses.
  • Of stimulant-involved overdoses, 67% involved cocaine and 38% involved methamphetamine.
  • Fatal overdoses from methamphetamine compared to cocaine were more frequent among younger Veterans, as were overdoses involving both stimulants and opioids.
  • Of all stimulant-related overdoses, 54% (1,965) also involved an additional substance, including 48% that co-involved opioids. Of stimulant + opioid-involved overdoses, 45% involved heroin and 46% involved synthetic opioids (e.g., fentanyl). Alcohol was the most common co-involved substance other than opioids.
  • Fewer than 30% of Veterans who died from stimulant-involved overdoses received treatment in a substance use disorder clinic in the year before death.


  • This study highlights vulnerable patient characteristics and treatment gaps for Veterans who die from stimulant overdose, suggesting a need for increased focus on polysubstance use treatment as well as distinct treatment needs based on stimulant use type.


  • Stimulant-related deaths can only be identified to the degree that post-mortem toxicology reports are run and substances reported on death certificates.
  • Data do not include services that Veterans may have received outside of VA, and therefore may underestimate treatment use.

Dr. Lin was supported by an HSR&D Career Development Award (CDA 18-008). Drs. Zhang, Bohnert, Maust, and Lin are part of HSR&D’s Center for Clinical Management Research (CCMR), Ann Arbor, MI.

Coughlin L, Zhang L, Bohnert A, Maust D, Goldstick J, and Lin L. Patient Characteristics and Treatment Utilization in Fatal Stimulant-Involved Overdoses in the United States Veterans Health Administration. Addiction. October 14, 2021; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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