Tripling of methamphetamine use among homeless and
marginally housed persons, 1996-2003
Judith Hahn, Moupali Das-Douglas, Grant Colfax, Andrew Moss, David Bangsberg
The REACH Study
Background
• Homeless and marginally housed persons suffer disproportionate levels of substance use disorders compared to the urban poor
• Reports suggestive of increasing methamphetamine (MA) use– DAWN – Emergency room visits increasingly MA-
related– SAMSHA – Drug treatment admissions increasingly
for MA
• Population-based studies have not been conducted
Study questions
• How much has MA use increased in the homeless?
• Have certain subgroups of the homeless been more affected than others?
Wave 1:
1996-1997
-------------
Wave 2:
1999-2000
---------------
Wave 3:
2003
---------
Methods• Three waves of cross sectional studies conducted at shelters and free meal programs in San Francisco
• Venues included in this analysis were sampled in at least 2 out of 3 waves
Study methods
• Inclusion criterion: Age 18 and older
• Structured interview
• HIV antibody testing and counseling
• Participants were paid $10-$20 for participating
MA definitions
• 1996-1997 wave: Uppers, speed, crank = amphetamines, methamphetamine, crystal, ice
• 1999-2000 wave: Methamphetamine = crystal, speed, crank, glass, ice
• 2003 wave: Methamphetamine, speed
Results
3100 interviews completed at shelters and lunch
lines, 1996-2003
• 2553 at the 10 venues in at least 2/3 waves
– 166 interviews for persons seen more than once per
wave were excluded from analysis
– 39 interviews missing MA data excluded
2348 observations for analysis
Demographics, n=2348
Male 78%Race
African American 48%Caucasian 35%Other, or mixed race 17%
Median age 42.5 (IQR: 36-49)Homeless* in the prior year 85%Median total years homeless* 2 (IQR: 0.5-5.0)
*Homeless = living in a shelter, on streets, in a squat, vehicle, park
Drug use, prior month, n=2348
Drank alcohol heavily* 29%
Injected drugs 14%
Used crack cocaine 32%
Used methamphetamine 9%
Injected methamphetamine 6%
Snorted methamphetamine 3%
Smoked methamphetamine 3%
*5 drinks/occasion for men, 4 drinks/occasion for women
HIV and sexual behavior, n=2348
HIV antibody positive 10%
Male sexual partners (among men) 26%
Number of sexual partners, prior year (n=1654)
0 25%
1-2 38%
3 37%
Sold sex, prior year (n=1631) 10%
MA trends by route of administrationProportion MA use prior 30 days
0.15
0.04
0.070.09
0.00
0.05
0.10
0.15
0.20
Allroutes
Inhaled Smoked Injected
1996-19971999-20002003
Trends in MA and other drugs
0.15
0.07
0.12
0.33
0.28
0.00
0.10
0.20
0.30
0.40
MA Powdercocaine
Heroin Crackcocaine
Heavyalcohol
1996-19971999-20002003
MA trends by age
0.33
0.13
0.07
0.00
0.10
0.20
0.30
0.40
Age 15-34 Age 35-49 Age >=50
1996-19971999-20002003
MA trends by race/ethnicity
0.24
0.05
0.20
0.00
0.10
0.20
0.30
0.40
White AfricanAmerican
Other
1996-19971999-20002003
MA trends by sex and behavior
0.09 0.11
0.28
0.00
0.10
0.20
0.30
0.40
Femal
e
Male
, het
eros
exual
MSM
1996-19971999-20002003
MA trends by duration homeless
0.120.16
0.00
0.10
0.20
0.30
0.40
<1 year >=1 year
1996-19971999-20002003
MA trends by living on street, prior year
0.07
0.25
0.00
0.10
0.20
0.30
0.40
0 months 1-12 months
1996-19971999-20002003
MA trends by years of education
0.16 0.17
0.12
0.00
0.10
0.20
0.30
0.40
<HS HS grad Somecollege
1996-19971999-20002003
MA trends by other drug use
0.44
0.07
0.15 0.15
0.00
0.10
0.20
0.30
0.40
IDU
NIDU
Hea
vy d
rinkin
g
No oth
er d
rug u
se
1996-19971999-20002003
MA trends by HIV status
0.14
0.22
0.00
0.10
0.20
0.30
0.40
HIV negative HIV positive
1996-19971999-20002003
(n=60)
MA trends by number of sex partners
0.06
0.11
0.23
0.00
0.10
0.20
0.30
0.40
0 1-2 >=3
Number of sexual partners, prior year
1996-19971999-20002003
• We also used multivariate logistic regression models to determine whether these trends could be explained by other changes in the population.
• The trends remained even after adjusting for age, sex, race/ethnicity, duration homeless and crack cocaine use.
Conclusions
• MA use tripled in the homeless, and increases were observed across most sub-groups
• The sharpest increases were among those under age 35 and among HIV positives
• Serious MA-related health issues include– Increased risk for serious psychiatric disorders– Sexual and injecting risk behavior dis-inhibition ==
greater risk for acquisition and transmission of infections
– Poor adherence to medications
Acknowledgements
• REACH study staff• NIH R01 MH54907• Contact info:
Judith Hahn, PhDAssistant ProfessorEPI Center, Department of MedicineUCSFSan Francisco, CA [email protected]