Examining the Impact of the Twin Epidemics of Methamphetamine and Opioid Use on Overdose, Risky Sex and Treatment Engagement Among PWUD in Two Rural Appalachian Cohorts

ABSTRACT The goal of this R01 renewal is to examine the impact of methamphetamine (MA) use on fatal and nonfatal overdose, engagement in injection- and sex-risk behaviors, and treatment for opioid use disorder (OUD) and other substance use disorders (SUD) among people who use drugs (PWUD) from two Appalachian cohorts. MA use among people who use opioids is increasing. Several recent publications have coined this increase in MA/opioid co-usage as the “twin epidemics”, as new onset methamphetamine use has been reported in areas particularly hard hit by the opioid epidemic. This application builds on work from two established cohort studies located in the epicenter of the opioid crisis - the Social Networks Among Appalachian People (SNAP) cohort and GATEWAY2HOPE (G2H). These cohorts will be combined to increase both geographic scope and statistical power and to examine the following aims: 1) To characterize use of methamphetamine in the context of continued opioid use (twin epidemics), initiation of meth use, and social networks of PWUM. Building on the data we have gathered for opioid use over time, additional prospective data will be collected on initiation and use patterns for methamphetamine, including route of administration; 2) To examine longitudinal changes in sex- and injection-risk behaviors as a result of initiation of meth use. Measures specific to this aim include fatal and non-fatal overdose, sharing of syringe and other injection paraphernalia, and unprotected sexual encounters. HIV, HCV and STI testing, as well as death certificate reviews will be conducted to complement self-reported behavioral data; and 3) determine impact of MA use on SUD/OUD treatment seeking, treatment initiation and long-term engagement in SUD treatment. While the data collected to date from the SNAP and CARE2HOPE cohorts have been invaluable in informing the opioid epidemic in rural Appalachia, it is important that this renewal be positioned to fill additional gaps in the literature. Currently, there is little information on the “twin epidemic” phenomenon and its potential impact on fatal and non-fatal overdoses, the SUD treatment cascade, and harm reduction services, especially in resource-deprived areas such as rural Appalachia. The proposed renewal will address these gaps and provide data that are integral to addressing drug-related harms in the rural U.S.