BACKGROUND AND AIMS: People who use methamphetamine have a standardised mortality ratio 6.8 times greater than the general population, with several countries reporting concerning increases in methamphetamine-related mortality over the past decade. Methamphetamine use in the United Kingdom (UK) has been reported as largely confined to communities of men who have sex with men (MSM) with no previous large-scale studies describing mortality associated with methamphetamine. We aimed to determine trends and case characteristics of methamphetamine-related deaths in the UK.

DESIGN: Retrospective cohort study.

SETTING: Coronial records submitted to the National Programme on Substance Use Mortality (NPSUM) in the UK, 1997-2024.

CASES: Decedents for whom methamphetamine was determined as implicated in death following coronial investigation.

MEASUREMENTS: Information was available on decedent sociodemographics, characteristics of death and drugs implicated in death.

FINDINGS: 136 decedents had methamphetamine implicated in death. The number of deaths per year were observed to be higher over time since the first death recorded in 2006 (2005-2010, 8 deaths; 2011-2015, 24 deaths; 2016-2020, 47 deaths; 2021-2024, 57 deaths). Decedents were predominantly male (n = 124, 91%) of White ethnicity (n = 68, 50%) with a mean age of 41.5 years (standard deviation 10.4; range 18-71); 77% had a history of substance dependence, 48% of which involved injecting drug use, and 88% had a history of a mental disorder. The median blood methamphetamine concentration detected at post-mortem was 0.83 mg/l (interquartile range 0.26, 2.5). Multiple drug toxicity was implicated in the majority of cases (n = 88, 65%), the most common implicated other drugs being cocaine (n = 27, 20%), gamma-hydroxybutyrate (n = 20, 15%), opioids (n = 20, 15%), benzodiazepines (n = 18, 13%), mephedrone (n = 13, 10%) and ketamine (n = 12, 8%). Accidental poisoning was the most common direct cause of death (n = 89, 65%), with other causes including intentional poisoning, cardiovascular disease, aspiration pneumonia and ischemic bowel disease.

CONCLUSIONS: Over the past two decades there appears to have been an increase in the number of methamphetamine-related deaths in the UK. These deaths largely involve polysubstance use within an overwhelmingly male population with a high prevalence of substance dependence and mental health disorders.