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 94143-1372Jhahn@epi-center.ucsf.edu