IntroductionThere may be an association between violence and methamphetamine use. We hypothesized that trauma patients screening positive for methamphetamines are more likely to present after penetrating trauma and have increased mortality.MethodsThe 2017–2019 TQIP was used to 1:2 match methamphetamine (meth+) patients to patients testing negative for all drugs (meth-). Patients with polysubstance/alcohol use were excluded. Bivariate and logistic regression analyses were performed.ResultsThe rate of methamphetamine use was 3.1 %. After matching, there was no difference in vitals, injury severity score, sex, and comorbidities between cohorts (allp> 0.05). Compared to meth-, the meth+ group was more commonly sustained penetrating trauma (19.8 % vs. 9.2 %,p< 0.001) with stab-wounds being the most common penetrating mechanism (10.5 % vs. 4.5 %,p< 0.001). The meth+group more commonly underwent surgery immediately from the emergency department (ED) (20.3 % vs. 13.3 %, p < 0.001). The associated risk of death in the ED was higher for the meth+group (OR 2.77, CI 1.45–5.28,p= 0.002), however, the risk was similar for patients that were admitted or received an operation (p= 0.065).ConclusionTrauma patients using methamphetamine more commonly presented after gun or knife violence and required immediate surgical intervention. They also have increased associated risk of death in the ED. Given these serious findings, a multidisciplinary approach in helping curtail the worsening epidemic of methamphetamine use appears warranted as it is related to penetrating trauma and outcomes.Level of evidenceIV.