Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-28T08:46:50.365Z Has data issue: false hasContentIssue false

Methamphetamine use and psychotic symptoms: findings from a New Zealand longitudinal birth cohort

Published online by Cambridge University Press:  17 June 2021

Joseph M. Boden*
Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, Christchurch Central City, Christchurch 8011, New Zealand
James A. Foulds
Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago Christchurch, Christchurch Central City, Christchurch 8011, New Zealand
Giles Newton-Howes
Department of Psychological Medicine, University of Otago, Wellington, New Zealand
Rebecca McKetin
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
Author for correspondence: Joseph M. Boden, E-mail:



This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth).


At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30–35 for those with and without a history of methamphetamine use prior to age 30.


After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03–1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02–1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21–6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use.


Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.

Original Article
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Arunogiri, S., Foulds, J. A., McKetin, R., & Lubman, D. I. (2018). A systematic review of risk factors for methamphetamine-associated psychosis. Australian and New Zealand Journal of Psychiatry, 52(6), 514529. doi: 10.1177/0004867417748750.CrossRefGoogle ScholarPubMed
Bell, C. J., Foulds, J. A., Horwood, L. J., Mulder, R. T., & Boden, J. M. (2019). Childhood abuse and psychotic experiences in adulthood: Findings from a 35-year longitudinal study. The British Journal of Psychiatry, 214(3), 153158. doi: 10.1192/bjp.2018.264.CrossRefGoogle ScholarPubMed
Bunting, P. J., Fulde, G. W. O., & Forster, S. L. (2007). Comparison of crystalline methamphetamine (“ice”) users and other patients with toxicology-related problems presenting to a hospital emergency department. Medical Journal of Australia, 187(10), 564566. doi: 10.5694/j.1326-5377.2007.tb01417.x.CrossRefGoogle ScholarPubMed
Callaghan, R. C., Cunningham, J. K., Allebeck, P., Arenovich, T., Sajeev, G., Remington, G., & Kish, S. J. (2012). Methamphetamine use and schizophrenia: A population-based cohort study in California. American Journal of Psychiatry, 169(4), 389396. doi: 10.1176/appi.ajp.2011.10070937.CrossRefGoogle ScholarPubMed
Carlin, J. B., Wolfe, R., Coffey, C., & Patton, G. C. (1999). Tutorial in biostatistics. Analysis of binary outcomes in longitudinal studies using weighted estimating equations and discrete-time survival methods: Prevalence and incidence of smoking in an adolescent cohort. Statistics in Medicine, 18, 26552679.3.0.CO;2-#>CrossRefGoogle Scholar
Cho, A. K. (1990). Ice: A new dosage form of an old drug. Science (New York, N.Y.), 249(4969), 631634. doi: 10.1126/science.249.4969.631.CrossRefGoogle Scholar
Cook, C. E., Jeffcoat, A. R., Hill, J. M., Pugh, D. E., Patetta, P. K., Sadler, B. M., & Perez-Reyes, M. (1993). Pharmacokinetics of methamphetamine self-administered to human subjects by smoking S-(+)-methamphetamine hydrochloride. Drug Metabolism and Disposition, 21(4), 717723.Google ScholarPubMed
Cruickshank, C. C., & Dyer, K. R. (2009). A review of the clinical pharmacology of methamphetamine. Addiction, 104(7), 10851099. doi: 10.1111/j.1360-0443.2009.02564.x.CrossRefGoogle ScholarPubMed
Degenhardt, L., Baxter, A. J., Lee, Y. Y., Hall, W., Sara, G. E., Johns, N., & Vos, T. (2014). The global epidemiology and burden of psychostimulant dependence: Findings from the Global Burden of Disease Study 2010. Drug and Alcohol Dependence, 137, 3647. doi: 10.1016/j.drugalcdep.2013.12.025.CrossRefGoogle ScholarPubMed
Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale: Preliminary report. Psychopharmacology Bulletin, 9, 1327.Google ScholarPubMed
Farrell, M., Martin, N. K., Stockings, E., Bórquez, A., Cepeda, J. A., Degenhardt, L., & McKetin, R. (2019). Responding to global stimulant use: Challenges and opportunities. The Lancet, 394(10209), 16521667. doi: 10.1016/S0140-6736(19)32230-5.CrossRefGoogle ScholarPubMed
Fergusson, D. M., & Horwood, L. J. (2001). The Christchurch health and development study: Review of findings on child and adolescent mental health. Australian and New Zealand Journal of Psychiatry, 35(3), 287296. doi: 10.1046/j.1440-1614.2001.00902.xCrossRefGoogle ScholarPubMed
Fergusson, D. M., Horwood, L. J., Shannon, F. T., & Lawton, J. M. (1989). The Christchurch child development study: A review of epidemiological findings. Paediatric and Perinatal Epidemiology, 3(3), 278301. doi: 10.1111/j.1365-3016.1989.tb00382.x.CrossRefGoogle ScholarPubMed
Fergusson, D. M., Horwood, L. J., & Swain-Campbell, N. R. (2003). Cannabis dependence and psychotic symptoms in young people. Psychological Medicine, 33(1), 1521.CrossRefGoogle ScholarPubMed
Glasner-Edwards, S., & Mooney, L. J. (2014). Methamphetamine psychosis: Epidemiology and management. CNS Drugs, 28(12), 11151126. doi: 10.1007/s40263-014-0209-8.CrossRefGoogle ScholarPubMed
Horwood, L. J., Fergusson, D. M., Hayatbakhsh, M. R., Najman, J. M., Coffey, C., Patton, G. C., & Hutchinson, D. (2010). Cannabis Use and educational achievement: Findings from three Australasian cohort studies. Drug and Alcohol Dependence, 110, 247253.CrossRefGoogle ScholarPubMed
Khosravi, A., & Mansournia, M. A. (2019). Recommendation on unbiased estimation of population attributable fraction calculated in “prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: A population based cross-sectional study”. Infectious Diseases of Poverty, 8(1), 75. doi: 10.1186/s40249-019-0587-8.CrossRefGoogle Scholar
Kuepper, R., van Os, J., Lieb, R., Wittchen, H. U., Hofler, M., & Henquet, C. (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. British Medical Journal, 342, d738.CrossRefGoogle ScholarPubMed
Lappin, J. M., Sara, G. E., & Farrell, M. (2017). Methamphetamine-related psychosis: An opportunity for assertive intervention and prevention. Addiction, 112(6), 927928. doi: 10.1111/add.13663.CrossRefGoogle ScholarPubMed
Liang, K.-Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73(1), 1322. doi: 10.1093/biomet/73.1.13.CrossRefGoogle Scholar
McKetin, R. (2018). Methamphetamine psychosis: Insights from the past. Addiction, 113(8), 15221527. doi: 10.1111/add.14170.CrossRefGoogle ScholarPubMed
McKetin, R., Kelly, E., & McLaren, J. (2006). The relationship between crystalline methamphetamine use and methamphetamine dependence. Drug and Alcohol Dependence, 85(3), 198204. doi: 10.1016/j.drugalcdep.2006.04.007.CrossRefGoogle ScholarPubMed
McKetin, R., Leung, J., Stockings, E., Huo, Y., Foulds, J., Lappin, J. M., & Degenhardt, L. (2019). Mental health outcomes associated with the use of amphetamines: A systematic review and meta-analysis. EClinicalMedicine, 16, 8197. doi: 10.1016/j.eclinm.2019.09.014.CrossRefGoogle ScholarPubMed
McKetin, R., Lubman, D. I., Baker, A. L., Dawe, S., & Ali, R. L. (2013). Dose-related psychotic symptoms in chronic methamphetamine users: Evidence from a prospective longitudinal study. JAMA Psychiatry, 70(3), 319324. doi: 10.1001/jamapsychiatry.2013.283.CrossRefGoogle ScholarPubMed
McKetin, R., Lubman, D. I., Najman, J. M., Dawe, S., Butterworth, P., & Baker, A. L. (2014). Does methamphetamine use increase violent behaviour? Evidence from a prospective longitudinal study. Addiction, 109(5), 798806. doi: 10.1111/add.12474.CrossRefGoogle ScholarPubMed
Niemi-Pynttäri, J. A., Sund, R., Putkonen, H., Vorma, H., Wahlbeck, K., & Pirkola, S. P. (2013). Substance-induced psychoses converting into schizophrenia: A register-based study of 18478 Finnish inpatient cases. Journal of Clinical Psychiatry, 74(1), e94e99. doi: 10.4088/JCP.12m07822.CrossRefGoogle Scholar
Robins, L. N., Cottler, L., Bucholz, K., & Compton, W. (1995). Diagnostic interview schedule for DSM-IV. St Louis, MO: Washington University Press.Google Scholar
United Nations Office on Drugs and Crime (2018). Methamphetamine continues to dominate synthetic drug markets. Retrieved from https// Scholar
Vaucher, J., Keating, B. J., Lasserre, A. M., Gan, W., Lyall, D. M., Ward, J., & Holmes, M. V. (2018). Cannabis use and risk of schizophrenia: A Mendelian randomization study. Molecular Psychiatry, 23(5), 12871292. doi: 10.1038/mp.2016.252.CrossRefGoogle ScholarPubMed
Wilkins, C., Sweetsur, P., & Griffiths, R. (2017). Recent trends in illegal drug use in New Zealand, 2006–2016: Findings from the Illicit Drug Monitoring System. Retrieved from Massey University, New Zealand:.Google Scholar
Supplementary material: File

Boden et al. supplementary material

Boden et al. supplementary material

Download Boden et al. supplementary material(File)
File 27.9 KB