Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances

L. Sarah Mixson; Bridget M. Whitney; Wiley D. Jenkins; Thomas J. Stopka; P. Todd Korthuis; Lydia N. Drumright; Stephanie A. Ruderman; Peter D. Friedmann; Mai T. Pho; April M. Young; Ryan P. Westergaard; David W. Seal; Vivian F. Go; William C. Miller; William A. Zule; Judith Feinberg; Hannah L.F. Cooper; Judith I. Tsui; Heidi M. Crane; Joseph A. Delaney

doi:10.1177/29768357241272374

Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances

L. Sarah Mixson, Bridget M. Whitney, Wiley D. Jenkins, Thomas J. Stopka, P. Todd Korthuis, Lydia N. Drumright, Stephanie A. Ruderman, Peter D. Friedmann, Mai T. Pho, April M. Young, Ryan P. Westergaard, David W. Seal, Vivian F. Go, William C. Miller, William A. Zule, Judith Feinberg, Hannah L.F. Cooper, Judith I. Tsui, Heidi M. Crane, Joseph A. Delaney

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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; P-value ⩽.001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95% CI: 0.61-0.85; P-value ⩽.001) and a personal history of overdose (aPR = 0.81; 95% CI = 0.73-0.90; P-value ⩽.001). Conclusion: 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.

Original language	English
Journal	Substance Use: Research and Treatment
Volume	18
DOIs	https://doi.org/10.1177/29768357241272374
State	Published - Jan 1 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Funding

The authors thank the other ROI investigators and their teams, the ROI Executive Steering Committee chair, Dr. Holly Hagan, the NIDA Science Officer, Dr. Richard Jenkins, and particularly, the participants of the individual ROI studies for their valuable contributions. A full list of participating ROI investigators and institutions can be found on the ROI website at http://ruralopioidinitiative.org/studies.html. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-study cohort with a common protocol which was developed collaboratively by investigators at 8 research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this publication is the result of secondary data harmonization and analysis and supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UG3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-study cohort with a common protocol which was developed collaboratively by investigators at 8 research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this publication is the result of secondary data harmonization and analysis and supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UG3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA.

Funders	Funder number
Centers for Disease Control and Prevention
Appalachian Regional Commission
Rural Opioid Initiative
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse
Substance Abuse and Mental Health Services Administration	UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044826/UH3DA044826, UG3DA044823/UH3DA044823, UG3DA044831/UH3DA044831, U24DA048538, UG3DA044822/UH3DA044822, UG3DA044830/UH3DA044830, UG3DA044825, U24DA044801
Substance Abuse and Mental Health Services Administration

Keywords

Heroin
drug of choice
drug overdose
harm reduction
methamphetamine
naloxone
polysubstance use
rural population

ASJC Scopus subject areas

Psychiatry and Mental health
Medicine (miscellaneous)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1177/29768357241272374

Cite this

Mixson, L. S., Whitney, B. M., Jenkins, W. D., Stopka, T. J., Korthuis, P. T., Drumright, L. N., Ruderman, S. A., Friedmann, P. D., Pho, M. T., Young, A. M., Westergaard, R. P., Seal, D. W., Go, V. F., Miller, W. C., Zule, W. A., Feinberg, J., Cooper, H. L. F., Tsui, J. I., Crane, H. M., & Delaney, J. A. (2024). Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances. Substance Use: Research and Treatment, 18. https://doi.org/10.1177/29768357241272374

@article{b2abfd7ecc43451e87bcb3bbbca93c8e,

title = "Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances",

abstract = "Background: The United States{\textquoteright} (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. Methods: 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. Results: 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; P-value ⩽.001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95\% CI: 0.61-0.85; P-value ⩽.001) and a personal history of overdose (aPR = 0.81; 95\% CI = 0.73-0.90; P-value ⩽.001). Conclusion: 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.",

keywords = "Heroin, drug of choice, drug overdose, harm reduction, methamphetamine, naloxone, polysubstance use, rural population",

author = "Mixson, \{L. Sarah\} and Whitney, \{Bridget M.\} and Jenkins, \{Wiley D.\} and Stopka, \{Thomas J.\} and Korthuis, \{P. Todd\} and Drumright, \{Lydia N.\} and Ruderman, \{Stephanie A.\} and Friedmann, \{Peter D.\} and Pho, \{Mai T.\} and Young, \{April M.\} and Westergaard, \{Ryan P.\} and Seal, \{David W.\} and Go, \{Vivian F.\} and Miller, \{William C.\} and Zule, \{William A.\} and Judith Feinberg and Cooper, \{Hannah L.F.\} and Tsui, \{Judith I.\} and Crane, \{Heidi M.\} and Delaney, \{Joseph A.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = jan,

day = "1",

doi = "10.1177/29768357241272374",

language = "English",

volume = "18",

}

Mixson, LS, Whitney, BM, Jenkins, WD, Stopka, TJ, Korthuis, PT, Drumright, LN, Ruderman, SA, Friedmann, PD, Pho, MT, Young, AM, Westergaard, RP, Seal, DW, Go, VF, Miller, WC, Zule, WA, Feinberg, J, Cooper, HLF, Tsui, JI, Crane, HM & Delaney, JA 2024, 'Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances', Substance Use: Research and Treatment, vol. 18. https://doi.org/10.1177/29768357241272374

TY - JOUR

T1 - Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances

AU - Mixson, L. Sarah

AU - Whitney, Bridget M.

AU - Jenkins, Wiley D.

AU - Stopka, Thomas J.

AU - Korthuis, P. Todd

AU - Drumright, Lydia N.

AU - Ruderman, Stephanie A.

AU - Friedmann, Peter D.

AU - Pho, Mai T.

AU - Young, April M.

AU - Westergaard, Ryan P.

AU - Seal, David W.

AU - Go, Vivian F.

AU - Miller, William C.

AU - Zule, William A.

AU - Feinberg, Judith

AU - Cooper, Hannah L.F.

AU - Tsui, Judith I.

AU - Crane, Heidi M.

AU - Delaney, Joseph A.

PY - 2024/1/1

Y1 - 2024/1/1

N2 - Background: 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. Methods: 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. Results: 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; P-value ⩽.001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95% CI: 0.61-0.85; P-value ⩽.001) and a personal history of overdose (aPR = 0.81; 95% CI = 0.73-0.90; P-value ⩽.001). Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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; P-value ⩽.001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95% CI: 0.61-0.85; P-value ⩽.001) and a personal history of overdose (aPR = 0.81; 95% CI = 0.73-0.90; P-value ⩽.001). Conclusion: 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.

KW - Heroin

KW - drug of choice

KW - drug overdose

KW - harm reduction

KW - methamphetamine

KW - naloxone

KW - polysubstance use

KW - rural population

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U2 - 10.1177/29768357241272374

DO - 10.1177/29768357241272374

M3 - Article

AN - SCOPUS:105000291039

SN - 1178-2218

VL - 18

JO - Substance Use: Research and Treatment

JF - Substance Use: Research and Treatment

ER -

Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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