Yen Li Mimi, Alba George A, Mitton Julian, Bearnot Benjamin
Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States.
Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, United States.
Addict Sci Clin Pract. 2021 Sep 26;16(1):57. doi: 10.1186/s13722-021-00267-1.
Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that individuals who use methamphetamine require greater access to treatment, there is still little known about methamphetamine use and treatment among individuals who are already engaged in outpatient substance use treatment.
To characterize care-engaged individuals who use methamphetamine to guide harm reduction and treatment strategies.
Retrospective cohort study of individuals at a large academic medical center in Massachusetts with ≥ 2 positive methamphetamine oral fluid toxicology tests between August 2019 and January 2020. We performed descriptive analysis of sociodemographic, medical, and drug use characteristics and a comparative analysis of injection methamphetamine use versus other routes of use.
Included were 71 individuals [56 male (80%), 66 non-Hispanic white (94%), median age 36 (IQR 30-42)]. Nearly all had opioid (94%) and stimulant use disorder (92%). Most had (93%) or were (83%) being treated with medications for opioid use disorder, but few received pharmacologic treatment for methamphetamine use disorder (24%). None received contingency management treatment. People who inject methamphetamine (68%) were more likely to have a history of overdose (91% vs. 70%; p = 0.02), have HCV (94% vs. 52%; p < 0.01), use fentanyl (93% vs. 65%; p = 0.02), and engage in sex work (19% vs. 0%; p = 0.03) compared to those who used via other routes. Both groups had prevalent homelessness (88% vs. 73%; p = 0.15), incarceration (81% vs. 64%; p = 0.11), depression (94% vs. 87%; p = 0.34), and bacteremia (27% vs. 22%; p = 0.63).
Individuals in our study had high prevalence of polysubstance use, particularly concomitant methamphetamine and opioid use. Individuals who were well connected to substance use treatment for their opioid use were still likely to be undertreated for their methamphetamine use disorder and would benefit from greater access to contingency management treatment, harm reduction resources, and resources to address adverse social determinants of health.
在美国，兴奋剂的使用呈上升趋势，2011年至2017年间，阿片类药物和甲基苯丙胺的使用量翻了一番。多物质使用模式的转变导致涉及精神兴奋剂的死亡人数不断增加。虽然已知使用甲基苯丙胺的个体需要更多的治疗途径，但对于已经接受门诊物质使用治疗的个体中甲基苯丙胺的使用和治疗情况仍知之甚少。
对使用甲基苯丙胺的接受治疗个体进行特征分析，以指导减少伤害和治疗策略。
对马萨诸塞州一家大型学术医疗中心的个体进行回顾性队列研究，这些个体在2019年8月至2020年1月期间甲基苯丙胺口服液毒理学检测呈阳性≥2次。我们对社会人口学、医学和药物使用特征进行了描述性分析，并对注射甲基苯丙胺与其他使用途径进行了比较分析。
纳入71名个体[56名男性（80%），66名非西班牙裔白人（94%），中位年龄36岁（IQR 30 - 42）]。几乎所有人都有阿片类药物（94%）和兴奋剂使用障碍（92%）。大多数人（93%）正在或（83%）接受阿片类药物使用障碍的药物治疗，但很少有人接受甲基苯丙胺使用障碍的药物治疗（24%）。没有人接受应急管理治疗。与通过其他途径使用的人相比，注射甲基苯丙胺的人（68%）更有可能有过量用药史（91%对70%；p = 0.02）、丙型肝炎病毒感染（94%对52%；p < 0.01）、使用芬太尼（93%对65%；p = 0.02）以及从事性工作（19%对0%；p = 0.03）。两组普遍存在无家可归（88%对73%；p = 0.15）、监禁（81%对64%；p = 0.11）、抑郁（94%对87%；p = 0.34）和菌血症（27%对22%；p = 0.63）。
我们研究中的个体多物质使用患病率很高，尤其是甲基苯丙胺和阿片类药物同时使用。因阿片类药物使用而与物质使用治疗联系紧密的个体，其甲基苯丙胺使用障碍仍可能治疗不足，且将受益于更多获得应急管理治疗、减少伤害资源以及解决健康不良社会决定因素的资源。
