Mixson L Sarah, Whitney Bridget M, Jenkins Wiley D, Stopka Thomas J, Korthuis P Todd, Drumright Lydia N, Ruderman Stephanie A, Friedmann Peter D, Pho Mai T, Young April M, Westergaard Ryan P, Seal David W, Go Vivian F, Miller William C, Zule William A, Feinberg Judith, Cooper Hannah Lf, Tsui Judith I, Crane Heidi M, Delaney Joseph A
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.
Subst Use. 2024 Aug 21;18:29768357241272374. doi: 10.1177/29768357241272374. eCollection 2024 Jan-Dec.
The United States' (US) opioid overdose epidemic has evolved into a combined stimulant/opioid epidemic, a pattern driven in part by mitigating opioid overdose risk, variable substance availability, and personal preferences. This study aimed to investigate the association between self-reported substance preference (heroin or methamphetamine) and behavioral/health outcomes among individuals who used both heroin and methamphetamine in the rural US.
The Rural Opioid Initiative is a consortium of 8 research cohorts from 10 states and 65 rural counties that recruited individuals reporting past 30-day injection of any substance or opioid substance use by any route from 1/2018 to 3/2020. Analyses were restricted to participants ⩾18 years, who self-reported either heroin or methamphetamine as their preferred substance and past 30-day use of both heroin and methamphetamine. We examined cross-sectional associations between preferred substance (heroin versus methamphetamine) and behavioral and health outcomes using random effects meta-analysis with adjusted regression models.
Among 1239 participants, 61% (n = 752) reported heroin as their preferred substance. Adjusting for age, sex, and race/ethnicity, methamphetamine preference was associated with lower prevalence ratios for current naloxone possession (adjusted prevalence ratio [aPR] = 0.68; 95% Confidence Interval [95% CI] = 0.59-0.78; -value ⩽ .001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95% CI: 0.61-0.85; -value ⩽ .001) and a personal history of overdose (aPR = 0.81; 95% CI = 0.73-0.90; -value ⩽ .001).
In our study analyzing associations between preferred substance and various behavioral and health outcomes amongst people who use both heroin and methamphetamine, a majority of participants preferred heroin. Methamphetamine preference was associated with lower prevalence of naloxone possession, ever being told they had HCV, and prior history of an overdose. This study underscores the need for targeted harm reduction services for people who prefer methamphetamine in rural areas.
美国的阿片类药物过量流行已演变成兴奋剂/阿片类药物联合流行，这种模式部分是由降低阿片类药物过量风险、物质供应的变化以及个人偏好驱动的。本研究旨在调查在美国农村同时使用海洛因和甲基苯丙胺的个体中，自我报告的物质偏好（海洛因或甲基苯丙胺）与行为/健康结果之间的关联。
农村阿片类药物倡议组织由来自10个州和65个农村县的8个研究队列组成，该组织在2018年1月至2020年3月期间招募了报告过去30天内通过任何途径注射任何物质或使用阿片类物质的个体。分析仅限于年龄≥18岁的参与者，他们自我报告海洛因或甲基苯丙胺为其首选物质，且过去30天内同时使用过海洛因和甲基苯丙胺。我们使用随机效应荟萃分析和调整后的回归模型，研究了首选物质（海洛因与甲基苯丙胺）与行为和健康结果之间的横断面关联。
在1239名参与者中，61%（n = 752）报告海洛因是他们的首选物质。在调整年龄、性别和种族/族裔后，甲基苯丙胺偏好与当前持有纳洛酮的患病率较低相关（调整后的患病率比值[aPR]=0.68；95%置信区间[95%CI]=0.59 - 0.78；P值≤.001），与曾被告知感染丙型肝炎病毒（HCV；aPR = 0.72；95%CI：0.61 - 0.85；P值≤.001）以及有过量用药个人史（aPR = 0.81；95%CI = 0.73 - 0.90；P值≤.001）相关。
在我们分析同时使用海洛因和甲基苯丙胺者的首选物质与各种行为和健康结果之间关联的研究中，大多数参与者更喜欢海洛因。甲基苯丙胺偏好与持有纳洛酮的患病率较低、曾被告知感染HCV以及有过量用药既往史相关。本研究强调了为农村地区更喜欢甲基苯丙胺的人群提供有针对性的减少伤害服务的必要性。
