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BACKGROUND: As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE: To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN: We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS: We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES: We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS: Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS: Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.
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Cocaína , Sobredosis de Droga , Metanfetamina , Trastornos Relacionados con Sustancias , Adulto , Humanos , Estados Unidos/epidemiología , Heroína , Analgésicos Opioides , Estudios Transversales , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
BACKGROUND: Hospital admissions involving substance use disorders are increasing and represent an opportunity to engage patients in substance use treatment. Addiction medicine consultation services improve access to medications for opioid use disorder (MOUD) and patient outcomes. However, as hospitals continue to adopt addiction medicine consultation services it is important to identify where disparities may emerge in the process of care. OBJECTIVE: To describe addiction medicine consultation service use by race and ethnicity as well as substance to identify opportunities to reduce substance use treatment disparities. DESIGN: Retrospective cohort study using 2016-2021 Electronic Health Record data from a large Midwest safety-net hospital. PARTICIPANTS: Hospitalized adults aged 18 or older, with one or more substance use disorders. MAIN MEASURES: Consultation orders placed, patient seen by consult provider, and receipt of MOUD by self-reported race. KEY RESULTS: Between 2016 and 2021, we identified 16,895 hospitalized patients with a substance use disorder. Consultation orders were placed for 6344 patients and 2789 were seen by the consult provider. Black patients were less likely (aOR = 0.58; 95% CI: 0.53-0.63) to have an addiction medicine consultation order placed and, among patients with a consultation order, were less likely (aOR = 0.74; 95% CI: 0.65-0.85) to be seen by the consult provider than White patients. Overall, Black patients with OUD were also less likely to receive MOUD in the hospital (aOR = 0.63; 95% CI: 0.50-0.79) compared to White patients. However, there were no differences in MOUD receipt among Black and White patients seen by the consult provider. CONCLUSIONS: Using Electronic Health Record data, we identified racial and ethnic disparities at multiple points in the inpatient addiction medicine consultation process. Addressing these disparities may support more equitable access to MOUD and other substance use treatment in the hospital setting.
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Medicina de las Adicciones , Trastornos Relacionados con Opioides , Adulto , Humanos , Etnicidad , Estudios Retrospectivos , Proveedores de Redes de Seguridad , Trastornos Relacionados con Opioides/tratamiento farmacológico , Derivación y Consulta , HospitalesRESUMEN
BACKGROUND: As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. METHODS: A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. RESULTS: There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. CONCLUSION: Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.
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Estimulantes del Sistema Nervioso Central , Sobredosis de Droga , Sobredosis de Opiáceos , Trastornos Relacionados con Opioides , Humanos , Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Estudios Transversales , Sobredosis de Droga/prevención & control , Estimulantes del Sistema Nervioso Central/uso terapéutico , Sobredosis de Opiáceos/tratamiento farmacológicoRESUMEN
INTRODUCTION: To guide improvements in treatment for pregnant persons with substance use disorders within the criminal legal system, treatment programs must first determine the primary substances of concern for this population. The objective of this study is to compare trends in specific substance use upon admission to treatment in pregnancy, based upon whether referrals originated from the criminal legal system or from another referral source. METHODS: This research accessed data on perinatal substance use (1995-2021) and referral sources from the Treatment Episode Data Set-Admissions (TEDS-A). Analyses use multiple logistic regressions to evaluate trends in primary substance use leading to treatment admission during pregnancy. RESULTS: Approximately 1 % (N = 536,948) of all substance use treatment admissions in TEDS-A were for pregnant people. Between 1995 and 2021, the percentage of treatment admissions increased for primary methamphetamine use (10 % to 27 %), primary opioid use (21 % to 38 %), and primary cannabis use (9 % to 18 %), and decreased for primary cocaine use (32 % to 6 %) and primary alcohol use (26 % to 11 %). By 2021, treatment admissions referred from criminal legal agencies were more likely to primarily be for primary methamphetamine use (33 % vs 25 %) and less likely to be for primary opioid use (22 % vs 42 %) compared to other referral sources. CONCLUSIONS: Trends in substance use treatment during pregnancy have changed substantially over the past few decades and emphasize the unique needs of patients referred to treatment by the criminal legal system. Treatment programs must therefore adapt to fluctuating trends in perinatal substance use. In particular, it is important to expand programs that prioritize treatment of methamphetamine use disorder for pregnant people referred through criminal legal agencies.
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Introduction: The US overdose crisis is increasingly characterized by opioid and methamphetamine co-use. Hospitalization is an important opportunity to engage patients in substance use treatment. Understanding characteristics of co-use-related hospital stays can inform the development of services to better support this growing patient population. Methods: We used 2016-2019 National Inpatient Sample data to conduct a cross sectional analysis of hospitalizations involving use of opioids, methamphetamine, or both. We used bivariate analysis to compare patient demographics. We then used multinomial logistic regressions to compare the proportion of hospital stays which indicated co-morbid diagnosis. To account for correlated data, we used generalized linear models to compare outcomes in hospital mortality, patient-directed discharge, and length of stay. Results: Co-use-related stays had a higher proportion of co-morbid mental health (60.7%; 95% CI: 59.9-61.4%) and infectious diseases (41.5%; 95% CI: 40.8-42.2%), than opioid- or methamphetamine-related stays. Co-use-related stays increased between 2016 and 2019 and were associated with a higher proportion of patient directed discharge (10.7%; 95% CI: 10.4-11.0%) and longer length of stay (6.3 days; 95% CI: 6.2-6.4 days) compared to opioid (8.1%; 95% CI: 7.9-8.3% and 5.8 days; 95% CI: 5.8-5.9 days) and methamphetamine-related stays (6.5%; 95% CI: 6.3-6.6% and 5.5 days; 95% CI: 5.4-5.5 days). Conclusion: Patients discharged with co-use differ from patients with opioid or methamphetamine use alone, representing a range of challenges and opportunities. In addition to offering treatment for both substance use disorders, hospital-based services that address co-occurring conditions may better support patients with co-use through targeted and tailored approaches.
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BACKGROUND: The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management for stimulant use disorders, most individuals with these co-occurring conditions are not engaged in treatment. Hospitalization is an important opportunity to engage patients and initiate treatment, however existing hospital addiction care is not tailored for patients with co-use and may not meet the needs of this population. METHODS: Semi-structured interviews were conducted with hospital providers about their experiences and perspectives treating patients with opioid and stimulant co-use. We used directed content analysis to identify common experiences and opportunities to improve hospital-based treatment for patients with co-use. RESULTS: From qualitative interviews with 20 providers, we identified 4 themes describing how co-use complicated hospital-based substance use treatment: (1) patients' unstable circumstances impacting the treatment plan, (2) co-occurring withdrawals are difficult to identify and treat, (3) providers holding more stigmatizing views of patients with co-use, and (4) stimulant use is often "ignored" in the treatment plans. Participants also described a range of potential opportunities to improve hospital-based treatment of co-use that fall into 3 categories: (1) provider practice changes, (2) healthcare system changes, and (3) development and validation of clinical tools and treatment approaches. CONCLUSIONS: We identified unique challenges providing hospital addiction medicine care to patients who use both opioids and stimulants. These findings inform the development, implementation, and testing of hospital-based interventions for patients with co-use.
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Sobredosis de Droga , Trastornos Relacionados con Opioides , Humanos , Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/complicaciones , Hospitales , Atención a la Salud , Sobredosis de Droga/complicacionesRESUMEN
Background: Individuals with criminal legal involvement (CLI), housing instability, or Medicaid insurance may experience barriers accessing substance use treatment in certain settings. Previous research has found individuals in these groups are less likely to receive medications for opioid use disorder (MOUD), but the role treatment setting may play in low rates of MOUD is unclear. Methods: We conducted a cross-sectional study using nationally representative survey data from 2015 to 2021. We estimated the proportion of individuals who had CLI, housing instability, or Medicaid insurance who received substance use treatment in a variety of settings. We used multivariable logistic regressions to estimate the associations between group and the receipt of MOUD across treatment settings. Results: Individuals with CLI, housing instability, or Medicaid insurance were more likely to receive substance use treatment in hospitals, rehabilitation, and mental health facilities compared with individuals not in these groups. However, all groups accessed substance use treatment in doctors' offices at similar rates. Treatment at a doctor's office was associated with the highest likelihood of receiving MOUD (aOR 4.73 [95% CI: 2.2.15-10.43]). Across multiple treatment settings, Individuals with CLI or housing instability were less likely to receive MOUD. Conclusions: Individuals with CLI, housing instability, or Medicaid insurance are more likely to access substance use treatment at locations associated with lower rates of MOUD use. MOUD access across treatment settings is needed to improve engagement and retention in treatment for patients experiencing structural disadvantage or who have low incomes.
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The drug overdose epidemic in the US necessitates detailed and timely data to inform public health responses. In this article we describe how an electronic health record (EHR) data-sharing collaboration across health systems in Minnesota that was developed in response to the COVID-19 pandemic was adapted to monitor trends in substance use-related hospital and emergency department (ED) visits. We found large increases in methamphetamine- and opioid-involved hospital and ED visits. Throughout the study period, Native American, Black, and multiple-race people experienced the highest rates of drug-involved hospital and ED visits. Monitoring drug-involved health care use through EHR data has the potential to help public health officials detect trends in near real time before mortality spikes and may also inform early intervention. The use of EHR data also allows for detailed monitoring of the impact of the drug overdose epidemic across racial and ethnic groups.
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Sobredosis de Droga , Pandemias , Humanos , Minnesota , Sobredosis de Droga/epidemiología , Analgésicos Opioides/uso terapéutico , Hospitales , Servicio de Urgencia en HospitalRESUMEN
BACKGROUND: Individuals involved in the criminal legal system face unique challenges to accessing substance use disorder (SUD) treatment, yet state-level variation in referrals for treatment remains largely unknown. To address disparities in the overdose crisis among individuals with criminal legal involvement, it is important to understand variation in SUD treatment across states. METHODS: We conducted a retrospective comparison of substance use treatment referrals from the criminal legal system and other sources across participating states. Using data from the 2018-2019 Treatment Episode Dataset-Admissions, we characterized treatment referral rates from the criminal legal system, the substances most commonly leading to treatment, and rates of treatment with medication for opioid use disorder (MOUD) across states. RESULTS: Across all states, criminal legal referral rates were higher than non-criminal legal rates. Criminal-legal referral rates, adjusted for state overdose deaths, were highest in the Northeast and Midwest. Methamphetamine use was the most common substance leading to treatment referral from the criminal legal system in 24 states while opioid use was the most common reason for non-criminal legal referrals in 34 states. In over half the states analyzed, fewer than 10% of opioid treatment referrals from the criminal legal system received MOUD. In almost all states, MOUD was more common in treatment referred from non-criminal legal settings. CONCLUSION: State-specific policies and practices shape drug policy and the SUD treatment landscape for people with criminal legal involvement. Standards and ongoing monitoring for substance use treatment referrals from the criminal-legal system should be considered by federal agencies charged with addressing the ongoing overdose crisis.
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Buprenorfina , Sobredosis de Droga , Metanfetamina , Trastornos Relacionados con Opioides , Humanos , Estados Unidos/epidemiología , Analgésicos Opioides/uso terapéutico , Estudios Retrospectivos , Trastornos Relacionados con Opioides/terapia , Trastornos Relacionados con Opioides/tratamiento farmacológico , Sobredosis de Droga/terapia , Sobredosis de Droga/tratamiento farmacológico , Derivación y Consulta , Tratamiento de Sustitución de Opiáceos , Buprenorfina/uso terapéuticoRESUMEN
OBJECTIVES: Safety-net hospitals disproportionately care for people with substance use disorders (SUDs), yet little is known about trends in hospital admissions related to specific substances. This study uses electronic health record data to describe trends in substance-specific admissions at a Midwest urban safety-net hospital. METHODS: We included all admissions from 2008 through 2020 and defined them as non-SUD (N = 154,477) or SUD-related (N = 63,667). We described patient characteristics and trends in substance-specific admissions. We estimated the association of SUD diagnoses with discharge against medical advice and length of stay using logistic regression and generalized linear models. RESULTS: Between 2008 and 2020, SUD-related admissions increased from 23.1% to 32.9% of total admissions. Admissions related to SUD had significantly more comorbidities than non-SUD-related admissions (4.7 vs 3.5, P < 0.001). Among illicit substances, cocaine-related admissions were the most common in 2008 (3.9% of total admissions, 17.2% of SUD admissions) whereas psychostimulants (eg, methamphetamines) were the most common in 2020 (7.8% of total admissions, 23.8% of SUD admissions). SUD-related hospitalizations had higher rates of against medical advice discharge (3.8%; 95% CI 3.6-3.9 vs 1.4%; 95% CI 1.3-1.4) and longer length of stay (6.3 days; 95% CI: 6.2-6.3 vs 5.3 days; 95% CI: 5.3-5.4) than non-SUD-related admissions. CONCLUSIONS: Over the study period, the proportion of admissions related to substance use rose to approximately one third of all admissions, driven by a rapidly increasing share of psychostimulant-related admissions. Identifying substance use patterns quickly using electronic health record data can help safety-net hospitals meet the needs of their patients and improve outcomes.
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Proveedores de Redes de Seguridad , Trastornos Relacionados con Sustancias , Comorbilidad , Hospitalización , Humanos , Alta del Paciente , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapiaRESUMEN
Background: Individuals experiencing homelessness or criminal justice involvement (CJI) have higher rates of substance use than the general public. Despite documented barriers to accessing treatment, few studies have compared substance use treatment patterns between these groups. Methods: This paper uses data from the Treatment Episode Dataset-Admissions between 2006 to 2018 to describe characteristics and trends in substance use treatment admissions indicating homelessness (n=2,524,413), CJI (4,764,750), both (509,902), or neither (8,950,797) in the United States. We used multivariable logistic regression to examine trends independent of demographic differences between groups. Findings: Between 2006 and 2018, the proportion of treatment admissions related to heroin increased across all groups. Methamphetamine-related admissions rose substantially for individuals experiencing homelessness, CJI, or both. By 2018, 27·8% (95% CI: 27·4-28·2%) of admissions for individuals experiencing both were methamphetamine-related and 16·7% (95% CI: 16·3-17·0%) were heroin-related. Conversely, among individuals experiencing neither, 7·5% (95% CI: 7·4-7·5%) of admissions were methamphetamine-related and 33·6% (95% CI: 33·4-33·7%) were heroin-related. Individuals experiencing both homelessness and CJI received lower rates of medications for opioid use disorder (OUD) (8·3%; 95% CI: 8·2-8·3%) compared to individuals experiencing neither (36·4%; 95% CI: 36·4-36·4%). Interpretation: Community treatment facilities should be supported to provide medications for OUD and accommodate rising rates of methamphetamine and polysubstance-related treatment admissions in populations experiencing complex social drivers of health such as homelessness, CJI, or both. Funding: National Institute of General Medical Sciences and National Institute of Diabetes and Digestive and Kidney Diseases.
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INTRODUCTION: Overdose deaths involving opioids and stimulants continue to reach unprecedented levels in the United States. Although significant attention has been paid to the relationship between prescription and illicit opioid use, little work has focused on the association between prescription and illicit stimulant use. Thus, this study explores characteristics of those who use or misuse prescription stimulants and/or opioids and associations with use of cocaine, methamphetamine, and heroin. METHODS: We used 2015-2020 data from the National Survey on Drug Use and Health. Using adjusted multivariable logistic regression, we estimated the associations between past year prescription stimulant or prescription opioid prescribed use and misuse; various demographic characteristics; and past-year cocaine, methamphetamine, or heroin use. RESULTS: From 2015 to 2020, 4.9 and 9.8 million US adults annually reported misusing prescription stimulants and opioids, respectively. Individuals who misused prescription stimulants were more likely to be ages 18-25 (45.8 %; 95 % CI: 44.0-47.5) than individuals who misused prescription opioids (21.7 %; 95 % CI: 20.7-22.7). We observed higher rates of cocaine use among individuals reporting prescription stimulant misuse (12.0 %; 95 % CI: 11.0-12.9) compared to those reporting prescription opioid misuse (5.7 %; 95 % CI: 5.1-6.3, p < 0.001). Heroin use was more common among individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.2) than prescription stimulant misuse (0.6 %; 95 % CI: 0.4-0.7, p < 0.001). However, rates of methamphetamine use among individuals with prescription stimulant misuse (2.4 %; 95 % CI: 1.9-3.0) did not differ from individuals with prescription opioid misuse (2.1 %; 95 % CI: 1.7-2.5, p = 0.67). CONCLUSIONS: Prescription stimulant misuse, compared to prescription opioid misuse, was associated with higher levels of cocaine use but not methamphetamine use. Treatment providers should consider screening for other substance use disorders among people who report prescription stimulant use or misuse. Additional research should seek to understand the mechanism underlying the different associations between prescription stimulant misuse and cocaine or methamphetamine use.
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Estimulantes del Sistema Nervioso Central , Cocaína , Metanfetamina , Trastornos Relacionados con Opioides , Mal Uso de Medicamentos de Venta con Receta , Adulto , Estados Unidos/epidemiología , Humanos , Adolescente , Adulto Joven , Analgésicos Opioides/uso terapéutico , Heroína , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , PrescripcionesRESUMEN
BACKGROUND: Non-emergent clinical services were limited or suspended during the early stages of the coronavirus disease 2019 (COVID-19) pandemic in the United States (U.S.). This could adversely impact epidemics of public health importance, such as HIV, and access to testing, which is a cornerstone of prevention efforts. METHODS: In this observational study, we collected HIV testing and positivity rate clinical data from four geographically diverse U.S. healthcare systems in New Orleans, Louisiana; Minneapolis, Minnesota; Providence, Rhode Island; and, Seattle, Washington. Data from 2019 to 2020 were examined to assess changes in HIV testing in community-based, emergency department, and outpatient settings. Poisson regression was used to explore trends in HIV testing through phases of the COVID-19 pandemic. FINDINGS: In outpatient settings, there was a 68-97% reduction in the number of HIV tests per week during each state's stay-at-home order period, compared to during the pre-stay-at-home order period in early 2020. HIV testing remained reduced 11-54% after states transitioned to advisory phases. The HIV positivity rate increased slightly at outpatient settings, except in New Orleans where it fell. INTERPRETATION: We found a concerning trend of substantially decreased HIV testing across four geographically diverse sites. These findings suggest that new HIV infections within the U.S. may be undiagnosed and not yet linked to clinical care and services, as a consequence of the COVID-19 pandemic. Thus, augmented efforts to identify patients and link them to HIV services will be needed as healthcare settings return to full operation. FUNDING: U.S. National Institute of Mental Health.
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We used data from a statewide public health-health system collaboration to describe trends in COVID-19 vaccination rates by racial and ethnic groups among people experiencing homelessness or incarceration in Minnesota. Vaccination completion rates among the general population and people incarcerated in state prisons were substantially higher than those among people experiencing homelessness or jail incarceration.
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COVID-19 , Personas con Mala Vivienda , Prisioneros , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Humanos , Minnesota , Prisiones , VacunaciónRESUMEN
BACKGROUND AND AIMS: The recent surge in methamphetamine use highlights the need for timely data on its health effects and healthcare service use impact. However, there is no ICD code for methamphetamine use. This study quantifies the positive predictive value of ICD-9-CM and ICD-10-CM psychostimulant codes for methamphetamine use. METHODS: A retrospective chart review of 220 adults aged 18 and older who had an inpatient admission with a psychostimulant-associated billing diagnosis at an urban safety-net hospital. Diagnoses were categorized as either methamphetamine-related or involving another specific psychostimulant. The positive predictive value of both ICD-9-CM or ICD-10-CM psychostimulant diagnosis codes for methamphetamine use was calculated. RESULTS: ICD-9-CM and ICD-10-CM psychostimulant codes had high positive predictive values of 78.2% (95% CI 70.3%-86.0%) and 85.5% (95% CI 78.8%-92.1%), respectively, for methamphetamine use. The most common non-methamphetamine psychostimulant in our cohort was khat, a cathinone-containing plant native to East Africa, accounting for psychostimulant-related diagnosis in 16 of the 220 hospitalizations. CONCLUSIONS: The high predictive values of psychostimulant codes for methamphetamine use support the application of administrative data in measuring methamphetamine-related healthcare use, as well as co-morbid health conditions and treatment patterns.
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Clasificación Internacional de Enfermedades , Metanfetamina , Adulto , Atención a la Salud , Humanos , Metanfetamina/efectos adversos , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
OBJECTIVE: To examine trends in polysubstance use among adults in treatment for opioid use disorder (OUD) and estimate associations between polysubstance use patterns and receipt of medications for OUD (MOUD). METHODS: We conducted a cross-sectional longitudinal analysis of treatment admissions for opioid use from 1992 to 2017 using the Treatment Episodes Data Set-Admissions (Nâ=â9,440,157). We used multiple logistic regression to examine co-use patterns and estimate associations between receipt of MOUD and polysubstance use categories (opioid only, any methamphetamine, any cocaine, any alcohol, any benzodiazepine). RESULTS: Between 1992 and 2017, treatment admissions involving opioid/cocaine (-17.2 percentage points [PP]) and opioid/alcohol co-use (-12.5 PP) decreased while opioid/methamphetamine (10.1 PP) and opioid/benzodiazepine co-use (5.6 PP) increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only (38.5%; 95% confidence interval [CI] 38.4-38.6) compared with individuals who used opioids with cocaine (35.7%; 95% CI 35.6-35.9), methamphetamine (23.9%; 95% CI 23.7-24.2), alcohol (25.0%; 95% CI 24.8-25.2), or benzodiazepines (34.6%; 95% CI 34.3-34.9). If those who co-used opioids with other substances received MOUD at the same rate as those who used opioids only, 47,400 additional people would have received MOUD between 2016 and 2017. CONCLUSIONS: Opioid/methamphetamine and opioid/benzodiazepine increased substantially between 1992 and 2017. Co-use of other substances with opioids was associated with significantly lower receipt of MOUD. Treatment facilities should increase access to MOUD for individuals who co-use opioids with other substances. This change would extend evidence-based treatment to thousands of individuals and save lives.
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Trastornos Relacionados con Opioides , Adulto , Analgésicos Opioides/uso terapéutico , Benzodiazepinas/uso terapéutico , Estudios Transversales , Humanos , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiologíaRESUMEN
BACKGROUND: Methamphetamine use, with and without opioids, has increased substantially, but little is known about the sociodemographic characteristics, substance use patterns, or health profiles of individuals who use methamphetamine. To design effective public health interventions, health care professionals and policymakers need data describing individuals who are using methamphetamine in the midst of the opioid crisis. METHODS: We used 2015-2018 data from the National Survey on Drug Use and Health and included non-elderly adults aged 18-64 years. We categorized respondents into three groups: use of opioids without methamphetamine use, use of methamphetamine without opioid use, or use of both opioids and methamphetamine. Multiple logistic regression models controlling for sociodemographic factors were used to compare substance use characteristics and measures of individual health between the three groups. RESULTS: People who used any methamphetamine were more likely to be unstably housed, low-income, and live in rural areas. Use of both opioids and methamphetamine was associated with a 132 % higher prevalence of injection needle use, and a nearly twofold higher prevalence of viral hepatitis compared with opioid use alone. One third of individuals reporting use of both opioids and methamphetamine had a severe mental illness, a 55 % higher prevalence than those using opioids alone. CONCLUSIONS: Individuals who used opioids and methamphetamine had more complex substance use and health profiles than individuals who used opioids alone. These findings suggest public health and harm reduction approaches designed to address opioid use remain important in an era of rising methamphetamine use.