Tripling of methamphetamine use among homeless and marginally

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 MArelated – 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?

Methods • Three waves of cross sectional studies conducted at shelters and free meal programs in San Francisco Wave 1: Wave 2: Wave 3: 1996 -1997 1999 -2000 2003 --------------- • 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 Race 78% African American Caucasian Other, or mixed race Median age Homeless* in the prior year Median total years homeless* 48% 35% 17% 42. 5 (IQR: 36 -49) 85% 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* Injected drugs Used crack cocaine Used methamphetamine Injected methamphetamine Snorted methamphetamine Smoked methamphetamine 29% 14% 32% 9% 6% 3% 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 administration Proportion MA use prior 30 days

Trends in MA and other drugs

MA trends by age

MA trends by race/ethnicity

MA trends by sex and behavior

MA trends by duration homeless

MA trends by living on street, prior year

MA trends by years of education

MA trends by other drug use

MA trends by HIV status (n=60)

MA trends by number of sex partners

• 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 R 01 MH 54907 • Contact info: Judith Hahn, Ph. D Assistant Professor EPI Center, Department of Medicine UCSF San Francisco, CA 94143 -1372 Jhahn@epi-center. ucsf. edu