Methamphetamine-Related Deaths

Medicolegal Data, 2005–2025

Methamphetamine is one of the most important illegal drugs in Germany. It causes massive mental and physical harms, such as dependence, psychosis, and stroke (1). Production, spread, and seizures have been increasing for years; in Europe, Czechia and neighboring German regions are known for their trade in inexpensive methamphetamine of high purity (2). In spite of the extent of methamphetamine-related disorders and because of care gaps aggravated by stigmatization, little is known about deaths in Germany that are associated with the consumption of this drug. The present study aimed to determine methamphetamine-associated mortality on the basis of a complete survey of forensic data spanning two decades and to sensitize the medical profession to this issue.

Methods

This retrospective study was approved by the ethics committee of the Dresden University of Technology (TUD) (SR-EK-33012020). In the years 2005 (start of the systematic recording of methamphetamine measurements in toxicology screening) to 2025, 8955 deaths in the region Dresden and eastern Saxony were autopsied by the institute of forensic medicine at TUD. We included in our analysis the data of all 120 dead patients in whose blood methamphetamine was confirmed post mortem. Demographic data (age, sex), mental disorders, blood test results (methamphetamine, alcohol), co-consumption (3,4-methylenedioxy-N-methylamphetamine [MDMA], cocaine, opioids, tetrahydrocannabinol [THC], gabapentinoids, benzodiazepines, tricyclic antidepressants, other antidepressants, antipsychotics, antihypertensives) and cause of death were extracted from the autopsy reports. For further methodological details, see Masing et al (3).

We used the software packages IBM SPSS version 30 und Microsoft Excel version 2405 for our descriptive statistics and the graphic processing of annual case numbers. To minimize statistical distortion resulting from varying numbers of autopsies, we calculated an annual ratio of methamphetamine-associated deaths to all autopsies.

Results

The sample of methamphetamine-associated deaths comprised 120 mainly male (77.5%) persons older than 18 years except for six neonates or stillbirths (median age: 32.00 years, interquartile range: 13.75). In 30.8% of deaths, drug dependence was documented, and in 15.0%, other mental disorders were known (psychosis: 7.5%, depression: 6.7%, attention deficit/hyperactivity disorder: 0.8%). The median blood concentration of methamphetamine and alcohol was 0.42 µg/mL (interquartile range: 0.98) and 0.00‰ (interquartile range: 0.25). In 42.5% of cases, co-consumption of sometimes more than one substance was documented (MDMA: 6.7%, cocaine: 0.8%, opioids: 10.0%, THC: 21.7%, gabapentinoids: 0.8%, benzodiazepines: 0.8%, tricyclic antidepressants: 0.8%, other antidepressants: 1.7%, antipsychotics: 3.3%, antihypertensives: 2.5%).

The primary causes of death were mainly non-natural (70.0%): intoxication (35.9%), hanging (10.8%), fall from height (9.2%), traffic crash (6.7%), stabbing or shooting injuries (5.0%), drowning (1.7%), and strangulation (0.8%). Natural primary causes of death (15.8%) were stroke or cerebral hemorrhage (4.2%), cardiac events (5.0%) such as myocardial infarction, myocarditis, or heart failure as well as other somatic events (6.7%) such as meningoencephalitis or blood sugar imbalances (hypoglycemia or hyperglycemia). In 14.2% of cases, the cause of death remained unknown—for example, because of severe body decomposition.

The methamphetamine-associated death rate of all forensic autopsies in the region of Dresden and eastern Saxony developed in waves, with an upward trend. This was characterized by a rise of 0.9% from 2005 to 3.2% in 2015, followed by a drop below the 2005 level in 2017 and a further rise to 1.7% in 2025 (Figure).

Figure

Proportion of methamphetamine-associated deaths in all autopsies. Toxicological investigations were ordered in about two-thirds of all autopsies consistently over the years, whereas the nationwide toxicology rate of forensic institutes was below 30%. For this reason, the probability was relatively high that a toxicological investigation in a methamphetamine-associated death was carried out in the region Dresden and eastern Saxony.

Discussion

The rising trend in methamphetamine-associated deaths in the forensic context in Dresden and eastern Saxony is reflected in the parliamentary circular 8/2969 of the Saxonian state parliament, in which for 2019–2024 an increase in deaths from narcotics in Saxony is documented and methamphetamine is named as the most common cause of death (https://edas.landtag.sachsen.de/redas/#/details?dokument_id=45636).

In our sample, consumers of methamphetamine were mainly male. Co-consumption was seen in almost one in two consumers, whose causes of death were mostly accidents or suicides, with intoxication the most common method. The median determined in the present study of 0.42 µg/mL is almost half the fatal methamphetamine dose of more than 1 µg/mL mentioned in the specialist literature. Regular consumption leads to neuroadaptive changes that result in the development of tolerance (4). Methamphetamine affects dopaminergic, noradrenergic, serotonergic, and glutamatergic signaling pathways that are crucially involved in impulse control, affect regulation, and decision making. The triggered neurobiological changes can lead to dysphoria, agitation, and paranoia, which can be assumed to contribute to the 4.4-fold increased risk for suicidality when consuming methamphetamine, as reported in a meta-analysis (5). This is shown as an example in a case report of an impulsive suicide of a person from the sample investigated in the present study (4).

The numbers of and trends in methamphetamine-associated deaths have to be interpreted with caution. The increase may have been affected by a more targeted commissioning of postmortem examinations and toxicological investigations. Furthermore, we can assume a high number of unreported cases of methamphetamine-associated deaths since postmortems are ordered primarily in cases where the cause of death is unknown or unnatural and toxicology exams are done selectively. In parallel, mental disorders are probably also under-reported, since the relevant details are based merely on autopsy reports. Furthermore, the retrospective study design cannot prove causality between methamphetamine consumption and cause of death. Also, the regional data do not allow for supra-regional conclusions.

Our results underline the urgent need for considering acute endangerment of self or others as an integral component of methamphetamine-related disorders (1). Because of the increasing Europe-wide consumption and associated high morbidity (2), screening for methamphetamine consumption more regularly is recommended in routine clinical and forensic practice. Furthermore, standardized screening and treatment algorithms should be developed so as to assess epidemiological trends more accurately and counteract them effectively.

Max Schallenberg, Jörg Pietsch, Henri Masing, Maik Spreer, Maximilian Pilhatsch, Johannes Petzold

Department of Psychiatry and Psychotherapy, University Medicine Dresden, Technical University Dresden, Germany (Schallenberg, Spreer, Pilhatsch, Petzold)
[e-mail]

Institute of Forensic Medicine, Technical University Dresden, Germany (Pietsch, Masing)

Department of Psychiatry and Psychotherapy, Municipal Hospital Dresden, Germany (Pilhatsch)

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 30 August 2025, revised version accepted on 24 February 2026.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Schallenberg M, Pietsch J, Masing H, Spreer M, Pilhatsch M, Petzold J: Methamphetamine-related deaths: Medicolegal data, 2005–2025. Dtsch Arztebl Int 2026; 123: 289–90. DOI: 10.3238/arztebl.m2026.0034

References

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2. European Union Drugs Agency (EUDA): Synthetic stimulants—the current situation in Europe. European Drug Report 2025. Lisbon: European ­Union Drugs Agency. www.euda.europa.eu/sites/default/files/pdf/32300_en.pdf?708504 (last accessed on 05 January 2026).

3. Masing H, Pietsch J: Analysis of the methamphetamine-related deaths in Eastern Saxony, Germany, between 2005 and 2019. Forensic Sci Med Pathol 2025; 21: 1240–7.

4. Schallenberg M, Pietsch J, Spreer M, Pilhatsch M, Petzold J: Impulsive suicide in methamphetamine intoxication and self-reported ADHD: A case report. Nervenarzt 2025; 96: 600–4

5. McKetin R, Leung J, Stockings E, et al.: Mental health outcomes ­associated with of the use of amphetamines: A systematic review and meta-analysis. EClinicalMedicine 2019; 16: 81–97.