University of Houston, United States of America; University of Wyoming.
University of Houston, United States of America; Delaware State University.
J Subst Use Addict Treat. 2024 Jul;162:209365. doi: 10.1016/j.josat.2024.209365. Epub 2024 Apr 16.
The opioid crisis continues to evolve with increasing opioid-related overdose deaths among under-represented minorities. A better understanding of substance use differences in the route of administration for people using heroin and other opioids can lead to targeted strategies and interventions.
Using the 2015-2019 Treatment Episode Data Set - Admissions (TEDS-A), a multinomial logistic regression model examined the relationship between race/ethnicity and secondary substance use with route of administration in a subset of 591,078 admissions.
For individuals reporting heroin as their primary substance, minoritized clients were both more likely to smoke (NH Blacks RR: 2.28, 95 % CI 2.16-2.41; Hispanic RR: 1.80, 95 % CI: 1.74, 1.87; Other RR: 2.09, 95 % CI: 2.00, 2.20) or inhale heroin (Hispanic RR: 1.82, 95 % CI 1.78-1.85; Other RR: 1.30, 95 % CI 1.25, 1.34) compared to non-Hispanic (NH) Whites. NH Black clients were nearly seven and a half times more likely to report inhaling (RR: 7.45, 95 % CI 7.28, 7.62) heroin over injecting it. Clients were more likely to smoke heroin compared to injection if they reported secondary drug use of methamphetamines (RR: 2.28, 95 % CI 2.21, 2.35) and other opioids (RR: 1.21, 95 % CI 1.15, 1.28). For clients reporting other opioids as their primary substance, Hispanic (RR: 1.33, 95 % CI 1.19, 1.47) and other racial/ethnic minority clients (RR: 2.50, 95 % CI 2.23, 2.79) were more likely to smoke opioids vs take it orally compared to their NH White counterparts. Individuals who reported methamphetamine use as a secondary substance were significantly more than three times as likely to smoke (RR: 3.07, 95 % CI 2.74, 3.45) or inject (RR: 3.36, 95 % CI 3.17, 3.57) compared to orally ingesting opioids, while those who reported cocaine or crack cocaine use were more than twice as likely to inject (RR: 2.22, 95 % CI 2.09-2.36) opioids than taking them orally.
Findings demonstrate significant racial and ethnic differences in the route of administration. This work expands on the understanding of the complex nature of polysubstance use in the evolving opioid crisis and the secondary substance use of clients on routes of administration of opioids and heroin, highlighting the need for tailored interventions to address the treatment needs of under-represented minorities.
阿片类药物危机仍在继续演变，代表性不足的少数群体中与阿片类药物相关的过量死亡人数不断增加。更好地了解使用海洛因和其他阿片类药物的人群在给药途径方面的物质使用差异，可以制定有针对性的策略和干预措施。
使用 2015-2019 年治疗入院数据（TEDS-A），在 591078 例入院患者的亚组中，使用多项逻辑回归模型研究种族/族裔与次要物质使用与给药途径之间的关系。
对于报告海洛因为主要药物的个体，少数民族患者更有可能吸烟（NH 黑人 RR：2.28，95%CI 2.16-2.41；西班牙裔 RR：1.80，95%CI：1.74，1.87；其他 RR：2.09，95%CI：2.00，2.20）或吸入海洛因（西班牙裔 RR：1.82，95%CI 1.78-1.85；其他 RR：1.30，95%CI 1.25，1.34）与非西班牙裔（NH）白人相比。NH 黑人患者报告吸入海洛因的可能性是注射海洛因的近七倍半（RR：7.45，95%CI 7.28，7.62）。与注射相比，如果患者报告使用安非他命（RR：2.28，95%CI 2.21，2.35）和其他阿片类药物（RR：1.21，95%CI 1.15，1.28）作为次要药物，则患者更有可能吸食海洛因。对于报告其他阿片类药物为主要药物的患者，西班牙裔（RR：1.33，95%CI 1.19，1.47）和其他种族/族裔少数群体（RR：2.50，95%CI 2.23，2.79）患者更有可能吸食阿片类药物，而不是口服。报告使用安非他命作为次要药物的个体更有可能吸食（RR：3.07，95%CI 2.74，3.45）或注射（RR：3.36，95%CI 3.17，3.57）阿片类药物，而不是口服，而报告使用可卡因或快克可卡因的个体则更有可能注射（RR：2.22，95%CI 2.09-2.36）阿片类药物，而不是口服。
研究结果表明，给药途径存在显著的种族和民族差异。这项工作扩展了对不断演变的阿片类药物危机中复杂的多物质使用以及阿片类药物和海洛因给药途径的次要物质使用的理解，强调需要量身定制干预措施，以满足代表性不足的少数群体的治疗需求。
