Evaluation of the BEAT Meth Intervention for Emergency Department Patients with Methamphetamine Psychosis

Abstract

ObjectivesMethamphetamine is the second leading cause of overdose death in America and a leading cause of emergency department (ED) visits. Methamphetamine-induced psychosis is a dangerous and difficult-to-treat consequence of methamphetamine use. We describe the pilot implementation and outcomes of a multimodal treatment intervention for ED patients with methamphetamine psychosis, Beginning Early and Assertive Treatment for Methamphetamine Psychosis (BEAT Meth).MethodsBEAT Meth was implemented in an urban safety net health system. The protocol includes early identification and treatment of methamphetamine psychosis, a protocolized hospitalization, and support for transitioning patients to specialty addiction treatment. Patients receiving BEAT Meth were compared with ED patients with methamphetamine psychosis who were discharged. Implementation fidelity was measured to assess feasibility.ResultsBEAT Meth patients were nearly 3 times more likely to attend an outpatient specialty addiction appointment in the 30 days after discharge than comparison patients (32% vs 11%, P < 0.01). Subsequent ED utilization was common among all patients, and there was no significant difference in 30-day ED return rates between BEAT Meth and comparison patients (28% vs 37%, P = 0.10). Exploratory analyses suggested that increased attendance at outpatient treatment reduced ED utilization.ConclusionsBEAT Meth is an intervention framework to support identification, management, and treatment engagement of ED patients with methamphetamine psychosis. Treatment strategies like BEAT Meth are necessary to manage the unique challenges of methamphetamine addiction. These findings will guide clinical care, program development, and research.

Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

“…50 At an urban safety net hospital, patients enrolled in an intervention, including early identification and treatment of methamphetamine psychosis, protocolized hospitalization, and linkage to outpatient treatment were more likely to attend an outpatient specialty addiction appointment. 51 Importantly, we found that providers frequently “ignored” stimulant use or did not differentiate between specific SUDs when patients used multiple substances. Stimulant-specific order sets may help standardize treatment and encourage hospital providers to address stimulant use by providing them with a protocolized treatment option.…”

Characteristics and co-morbidities associated with hospital discharges for opioid and methamphetamine co-use, United States 2016–2019

“…Hospitals may need to provide additional supports the address the comorbidities and referral process to outpatient treatment to improve patient outcomes for this unique population. For example, one safety-net hospital implemented an early identification, medication, and behavioral management protocol for methamphetamine use which was associated with increased outpatient addiction treatment attendance ( Simpson et al, 2023 ). Additionally, the high proportion of methamphetamine- and co-use-involved stays which were paid for by Medicaid highlights the importance of Substance Use and Mental Health Block Grants and 1115 Waivers for developing and testing treatment approaches.…”

“…Hospitalizations indicating methamphetamine or co-use had a high proportion of schizophrenia and psychosis. It is important that care teams are able to differentiate between, and appropriately treat, methamphetamine-induced psychosis and other psychiatric conditions ( Priest et al, 2023 ; Simpson et al, 2023 ). Additionally, we found a high proportion of methamphetamine- and co-use related stays also indicated PTSD or.…”

“That Line Just Kept Moving”: Motivations and Experiences of People Who Use Methamphetamine

“…9 Methamphetamine is a leading cause of substancerelated ED visits. 10,11 The reasons for seeking ED care when using methamphetamine varies with patients requiring anything from medical evaluation for chest pain to sedation and psychiatric evaluation for agitation and psychosis. 12 In some areas, behavioral crises related to methamphetamine use account for half of psychiatric emergency services visits.…”