Acute health service use among people who died from methamphetamine-related causes in New South Wales and Victoria

BACKGROUND: Despite increased methamphetamine-related harms in Australia, little is known about healthcare contacts amongst those who die from methamphetamine-related causes. The study aims to describe the proportion and incidence rates of acute health service contacts preceding methamphetamine-related death in New South Wales and Victoria. METHODS: We conducted a retrospective analysis of acute health service use among people who died from methamphetamine-related causes in New South Wales and Victoria (2008-2021), using linked ambulance, emergency department, and hospital data (2007-2021). Proportions of individuals with any service contact and incidence rates (contacts per person-year) were calculated and stratified by sex, age and state, across the entire period, 12 months, and 30 days prior to death. RESULTS: There were 2,075 methamphetamine-related deaths in New South Wales and 2,045 in Victoria between 1 July 2008 and 31 December 2021. Over 90% had at least one acute healthcare contact prior to death, with the emergency department the most common point of contact. Two-thirds had acute service use in the 12 months, and one-third in the 30 days before death. Incidence rates of contacts for each service increased with proximity to death, peaking in the 30 days prior. Increases were greatest for emergency department presentations, ranging from 1.2 to 1.4 contacts per person-year for the entire period before death to 2.4-2.7 in the year before death. Incidence rates of ambulance, emergency department and hospital contacts increased over time in New South Wales and Victoria. A small proportion (8-9%) of decedents had no recorded acute service use. CONCLUSIONS: The high proportion and increasing incidence rates of acute healthcare contact in the year preceding death involving methamphetamines highlights points of engagement where earlier intervention strategies could be strengthened, particularly in emergency departments. Findings suggest the need for coordinated pathways from acute settings into ongoing care for people who use methamphetamine.