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Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities

IMPORTANCE: Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. OBJECTIVE: To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether m...

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Autores principales: Korthuis, P. Todd, Cook, Ryan R., Foot, Canyon A., Leichtling, Gillian, Tsui, Judith I., Stopka, Thomas J., Leahy, Judith, Jenkins, Wiley D., Baker, Robin, Chan, Brian, Crane, Heidi M., Cooper, Hannah L., Feinberg, Judith, Zule, William A., Go, Vivian F., Estadt, Angela T., Nance, Robin M., Smith, Gordon S., Westergaard, Ryan P., Van Ham, Brent, Brown, Randall, Young, April M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379740/
https://www.ncbi.nlm.nih.gov/pubmed/35969400
http://dx.doi.org/10.1001/jamanetworkopen.2022.26544
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author Korthuis, P. Todd
Cook, Ryan R.
Foot, Canyon A.
Leichtling, Gillian
Tsui, Judith I.
Stopka, Thomas J.
Leahy, Judith
Jenkins, Wiley D.
Baker, Robin
Chan, Brian
Crane, Heidi M.
Cooper, Hannah L.
Feinberg, Judith
Zule, William A.
Go, Vivian F.
Estadt, Angela T.
Nance, Robin M.
Smith, Gordon S.
Westergaard, Ryan P.
Van Ham, Brent
Brown, Randall
Young, April M.
author_facet Korthuis, P. Todd
Cook, Ryan R.
Foot, Canyon A.
Leichtling, Gillian
Tsui, Judith I.
Stopka, Thomas J.
Leahy, Judith
Jenkins, Wiley D.
Baker, Robin
Chan, Brian
Crane, Heidi M.
Cooper, Hannah L.
Feinberg, Judith
Zule, William A.
Go, Vivian F.
Estadt, Angela T.
Nance, Robin M.
Smith, Gordon S.
Westergaard, Ryan P.
Van Ham, Brent
Brown, Randall
Young, April M.
author_sort Korthuis, P. Todd
collection PubMed
description IMPORTANCE: Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. OBJECTIVE: To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses. DESIGN, SETTING, AND PARTICIPANTS: From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022. EXPOSURES: Use of methamphetamine alone, opioids alone, or both. MAIN OUTCOMES AND MEASURES: Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses. RESULTS: Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ(2)(2) = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone. CONCLUSIONS AND RELEVANCE: These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities.
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spelling pubmed-93797402022-08-26 Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities Korthuis, P. Todd Cook, Ryan R. Foot, Canyon A. Leichtling, Gillian Tsui, Judith I. Stopka, Thomas J. Leahy, Judith Jenkins, Wiley D. Baker, Robin Chan, Brian Crane, Heidi M. Cooper, Hannah L. Feinberg, Judith Zule, William A. Go, Vivian F. Estadt, Angela T. Nance, Robin M. Smith, Gordon S. Westergaard, Ryan P. Van Ham, Brent Brown, Randall Young, April M. JAMA Netw Open Original Investigation IMPORTANCE: Overdoses continue to increase in the US, but the contribution of methamphetamine use is understudied in rural communities. OBJECTIVE: To estimate the prevalence of methamphetamine use and its correlates among people who use drugs (PWUD) in rural US communities and to determine whether methamphetamine use is associated with increased nonfatal overdoses. DESIGN, SETTING, AND PARTICIPANTS: From January 2018 through March 2020, the National Rural Opioid Initiative conducted cross-sectional surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin). Participants included rural PWUD who reported any past-30-day injection drug use or noninjection opioid use to get high. A modified chain-referral sampling strategy identified seeds who referred others using drugs. Data analysis was performed from May 2021 to January 2022. EXPOSURES: Use of methamphetamine alone, opioids alone, or both. MAIN OUTCOMES AND MEASURES: Unweighted and weighted prevalence of methamphetamine use, any past-180-day nonfatal overdose, and number of lifetime nonfatal overdoses. RESULTS: Among the 3048 participants, 1737 (57%) were male, 2576 (85%) were White, and 225 (7.4%) were American Indian; the mean (SD) age was 36 (10) years. Most participants (1878 of 2970 participants with any opioid or methamphetamine use [63%]) reported co-use of methamphetamine and opioids, followed by opioids alone (702 participants [24%]), and methamphetamine alone (390 participants [13%]). The estimated unweighted prevalence of methamphetamine use was 80% (95% CI, 64%-90%), and the estimated weighted prevalence was 79% (95% CI, 57%-91%). Nonfatal overdose was greatest in people using both methamphetamine and opioids (395 of 2854 participants with nonmissing overdose data [22%]) vs opioids alone (99 participants [14%]) or methamphetamine alone (23 participants [6%]). Co-use of methamphetamine and opioids was associated with greater nonfatal overdose compared with opioid use alone (adjusted odds ratio, 1.45; 95% CI, 1.08-1.94; P = .01) and methamphetamine use alone (adjusted odds ratio, 3.26; 95% CI, 2.06-5.14; P < .001). Those with co-use had a mean (SD) of 2.4 (4.2) (median [IQR], 1 [0-3]) lifetime overdoses compared with 1.7 (3.5) (median [IQR], 0 [0-2]) among those using opioids alone (adjusted rate ratio, 1.20; 95% CI, 1.01-1.43; P = .04), and 1.1 (2.9) (median [IQR], 0 [0-1]) among those using methamphetamine alone (adjusted rate ratio, 1.81; 95% CI, 1.45-2.27; P < .001). Participants with co-use most often reported having tried and failed to access substance use treatment: 827 participants (44%) for both, 117 participants (30%) for methamphetamine alone, and 252 participants (36%) for opioids alone (χ(2)(2) = 33.8; P < .001). Only 66 participants (17%) using methamphetamine alone had naloxone. CONCLUSIONS AND RELEVANCE: These findings suggest that harm reduction and substance use disorder treatment interventions must address both methamphetamine and opioids to decrease overdose in rural communities. American Medical Association 2022-08-15 /pmc/articles/PMC9379740/ /pubmed/35969400 http://dx.doi.org/10.1001/jamanetworkopen.2022.26544 Text en Copyright 2022 Korthuis PT et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Korthuis, P. Todd
Cook, Ryan R.
Foot, Canyon A.
Leichtling, Gillian
Tsui, Judith I.
Stopka, Thomas J.
Leahy, Judith
Jenkins, Wiley D.
Baker, Robin
Chan, Brian
Crane, Heidi M.
Cooper, Hannah L.
Feinberg, Judith
Zule, William A.
Go, Vivian F.
Estadt, Angela T.
Nance, Robin M.
Smith, Gordon S.
Westergaard, Ryan P.
Van Ham, Brent
Brown, Randall
Young, April M.
Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities
title Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities
title_full Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities
title_fullStr Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities
title_full_unstemmed Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities
title_short Association of Methamphetamine and Opioid Use With Nonfatal Overdose in Rural Communities
title_sort association of methamphetamine and opioid use with nonfatal overdose in rural communities
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379740/
https://www.ncbi.nlm.nih.gov/pubmed/35969400
http://dx.doi.org/10.1001/jamanetworkopen.2022.26544
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