Purpose: To review the risk factors of perforated peptic ulcers (PPU) and compare the rate of intravenous methamphetamine use in these patients with the rate of use within Queensland’s adult population (1.5%). Smoking, alcohol and non-steroidal anti-inflammatory drugs (NSAIDs) have been described as risk factors for peptic ulcer disease (PUD), however limited evidence suggests linking methamphetamine use to PPU. (1) Methodology: 400 patients presenting to Townsville University Hospital with PUD between 2017-2023 were included in this retrospective cohort study. Electronic medical records were reviewed for demographics, risk factors, management and outcomes. Total 61 were determined to have a PPU. Results: Intravenous methamphetamine users accounted for 7.3% (n=7) of presentations. In the non-intravenous drug use population, smoking (56.8%), NSAIDs (40.9%) and alcohol consumption (40.9%) were considered the most common risk factors. The methamphetamine subgroup however comprised of smokers (100%), alcohol users (85%) and only 14.3% NSAID users. Methamphetamine users were also more commonly male and younger than the comparative population (median age 33 years-old vs. 61.5 years-old). Median hospital length of stay and complication rate including re-operation was comparable between the groups. Conclusions: This study identified risk factor trends and that rates of IV methamphetamine use were greater in the PPU group versus the general population. Whilst unable to demonstrate causation, by increasing awareness, this may enable surgeons to identify at-risk patients, improve surgical outcomes and reduce re-perforation. References: 1. Queensland Health, Tobacco, alcohol and illicit drug use in Queensland 2016. Analysis of the AIHW National Drug Strategy Household Survey 2016. Brisbane 2019