Twin epidemics: The surging rise of methamphetamine use in chronic opioid users

Ellis, Matthew S.; Kasper, Zachary A.; Cicero, Theodore J.

doi:10.1016/j.drugalcdep.2018.08.029

Cited by 288 publications

(234 citation statements)

References 22 publications

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“…Although previous studies provide important insights into the emerging issue of methamphetamine use among people using heroin in the United States, due to their small sample sizes, geographic specificity and limited examination of socio‐demographic characteristics, they are limited in their ability to identify national and regional trends and to characterize populations at risk for using heroin and methamphetamine. To address this gap and to inform prevention, treatment, and response efforts, we examined nation‐wide treatment admission data in the United States from 2008 to 2017.…”

Section: Introductionsupporting

confidence: 89%

“…In the United States, emerging research suggests that the increase in methamphetamine use is intertwined with the evolving opioid overdose epidemic . Among people who inject drugs (PWID) engaging with syringe services programs in King County, Washington, combined heroin and methamphetamine injection in the past 3 months increased from 18% in 2009 to 31% in 2017 among men who have sex with men (MSM) and from 10 to 53% among non‐MSM .…”

Section: Introductionmentioning

confidence: 99%

“…Ellis et al . found that among people seeking treatment for opioid use disorder (OUD) from approximately 170 treatment facilities in the United States, past‐month use of methamphetamine increased from 18.8% in the second quarter of 2011 to 34.2% in the first quarter of 2017 .…”

Section: Introductionmentioning

confidence: 99%

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Increases in methamphetamine use among heroin treatment admissions in the United States, 2008–17

2019

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Background and Aims Due to their small sample sizes, geographic specificity and limited examination of socio-demographic characteristics, recent studies of methamphetamine use among people using heroin in the United States are limited in their ability to identify national and regional trends and to characterize populations at risk for using heroin and methamphetamine. This study aimed to examine trends and correlates of methamphetamine use among heroin treatment admissions in the United States. Design Longitudinal analysis of data from the 2008 to 2017 Treatment Episode Data Set.Descriptive statistics, trend analyses and multivariable logistic regression were used to examine characteristics associated with methamphetamine use among heroin treatment admissions. Setting United States. Participants Treatment admissions of people aged ≥ 12 years whose primary substance of use is heroin. Measurements Primary measurement was heroin treatment admissions involving methamphetamine. Secondary measurements were demographics of sex, age, race/ethnicity, US census region, living arrangement and employment status. Findings The percentage of primary heroin treatment admissions reporting methamphetamine use increased each year from 2.1% in 2008 to 12.4% in 2017, a relative percentage increase of 490% and an annual percentage change (APC) of 23.4% (P < 0.001). During the study period, increases were seen among males and females and among all demographic and geographic groups examined. Among primary heroin treatment admissions reporting methamphetamine use in 2017, 47.1% reported injecting, 46.0% reported smoking, 5.1% reporting snorting and 1.8% reported oral/other as their usual route of methamphetamine use. Conclusions Methamphetamine use among heroin treatment admissions in the United States increased from one in 50 primary heroin treatment admissions in 2008 to one in 8 admissions in 2017.

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Section: Introductionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Increases in methamphetamine use among heroin treatment admissions in the United States, 2008–17

2019

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“…Though unknown, it is also possible that methamphetamine use is a marker for 290 social marginalization or other factors that might make people less likely to initiate MOUD/MAUD. Co-291 use of methamphetamines and opioids is increasingly common due to synergistic euphoric or balancing 292 effects; easier access to methamphetamine; social pressures to co-use; and co-use as a marker for more 293 severe SUD (Ellis et al, 2018). How these factors effect non-treatment seeking, hospitalized adults 294 remains unclear.…”

Section: Discussion 239mentioning

confidence: 99%

Predictors of Opioid and Alcohol Pharmacotherapy Initiation at Hospital Discharge Among Patients Seen by an Inpatient Addiction Consult Service

Englander

King

Nicolaidis

et al. 2019

Journal of Addiction Medicine

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Background: Medications for opioid use disorder (MOUD) and alcohol use disorder (MAUD) are effective and under-prescribed. Hospital-based addiction consult services can engage out-of-treatment adults in addictions care. Understanding which patients are most likely to initiate MOUD and MAUD can inform interventions and deepen understanding of hospitals’ role in addressing substance use disorders (SUD). Objective: Determine patient- and consult-service level characteristics associated with MOUD/MAUD initiation during hospitalization. Methods: We analyzed data from a study of the Improving Addiction Care Team (IMPACT), an interprofessional hospital-based addiction consult service at an academic medical center. Researchers collected patient surveys and clinical data from September 2015 to May 2018. We used logistic regression to identify characteristics associated with medication initiation among participants with OUD, AUD, or both. Candidate variables included patient demographics, social determinants, and treatment-related factors. Results: Three hundred thirty-nine participants had moderate to severe OUD, AUD, or both and were not engaged in MOUD/MAUD care at admission. Past methadone maintenance treatment (aOR 2.07, 95%CI (1.17, 3.66)), homelessness (aOR 2.63, 95%CI (1.52, 4.53)), and partner substance use (aOR 2.05, 95%CI (1.12, 3.76) were associated with MOUD/MAUD initiation. Concurrent methamphetamine use disorder (aOR 0.32, 95%CI (0.18, 0.56)) was negatively associated with MOUD/MAUD initiation. Conclusions: The association of MOUD/MAUD initiation with homelessness and partner substance use suggests that hospitalization may be an opportunity to reach highly-vulnerable people, further underscoring the need to provide hospital-based addictions care as a health-system strategy. Methamphetamine's negative association with MOUD/MAUD warrants further study.

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“…Other substance dependence or abuse has been associated with opioid misuse based on varying risk factors. 19, 25−28 In this study, we specifically found that nicotine, 25,29 marijuana, 25 cocaine, 28 methamphetamine, 30 tranquilizers, 31−33 and stimulants 34 increase the probability toward opioid misuse. Although the present study revealed an increased association of opioid misuse with marijuana compared to non-marijuana users, the relationship in the literature has been mixed.…”

Section: Discussionmentioning

confidence: 75%

Biopsychosocial factors associated with opioid misuse in a 2017-2018 United States national survey: A comprehensive multivariate model

Ishino¹,

Gilreath²,

Salmeron³

et al. 2020

Preprint

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Background Few studies have comprehensively and contextually examined the relationship of variables associated with opioid misuse. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse in the United States by identifying the most salient predictors. MethodsA multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N=85,580; weighted N=248,008,986). The outcome of opioid misuse was based on reported prescription pain reliever and/or heroin dependence or abuse. Biopsychosocial predictors of opioid misuse in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators.Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives). Results The comprehensive model found that criminality (adjusted odds ratio [AOR]=2.58, 95% confidence interval [CI]=1.98-3.37, p<0.001), self-reported health (i.e., excellent compared to fair/poor [AOR=3.71, 95%CI=2.19-6.29, p<0.001], good [AOR=3.43, 95%CI=2.20-5.34, p<0.001], and very good [AOR=2.75, 95%CI=1.90-3.98, p<0.001]), no private health insurance (AOR=2.12, 95%CI=1.55-2.89, p<0.001), serious psychological distress (AOR=2.12, 95%CI=1.55-2.89, p<0.001), suicidality (AOR=1.58, 95%CI=1.17-2.14, p=0.004), and other substance dependence or abuse were significant predictors of opioid misuse. Substances associated were nicotine (AOR=3.01, 95%CI=2.30-3.93, p<0.001), alcohol (AOR=1.40, 95%CI=1.02-1.92, p=0.038), marijuana (AOR=2.24, 95%CI=1.40-3.58, p=0.001), cocaine (AOR=3.92, 95%CI=2.14-7.17, p<0.001), methamphetamine (AOR=3.32, 95%CI=1.96-5.64, p<0.001), tranquilizers (AOR=16.72, 95%CI=9.75-28.65, p<0.001), and stimulants (AOR=2.45, 95%CI=1.03-5.87, p=0.044).

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Twin epidemics: The surging rise of methamphetamine use in chronic opioid users

Cited by 288 publications

References 22 publications

Increases in methamphetamine use among heroin treatment admissions in the United States, 2008–17

Increases in methamphetamine use among heroin treatment admissions in the United States, 2008–17

Predictors of Opioid and Alcohol Pharmacotherapy Initiation at Hospital Discharge Among Patients Seen by an Inpatient Addiction Consult Service

Biopsychosocial factors associated with opioid misuse in a 2017-2018 United States national survey: A comprehensive multivariate model

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