Ranking of substances by community problem severity

1. Agency Staff Perceptions of Problems Related to Methamphetamine and Other Drug Use in Native American Communities in the Four-Corners Region M.P. Bogenschutz1, A. Mondragon1, A. Reid1, J. Houck1, A. Forcehimes1, M. Davis1, K. Foley2 1University of New Mexico Center on Alcoholism, Substance Abuse and Addictions (CASAA) University of New Mexico, Albuquerque, NM 3The Na’Nizhoozhi Center Inc., Gallup, NM NA’NIZHOOZHI CENTER A BRIDGE TO RECOVERY Ranking of substances by community problem severity Participants were asked to rank the 5 most problematic substances for Native Americans in their communities. Rankings are shown below (N.R.=Not Ranked). Most respondents (73%) identified alcohol as the number one problem substance, followed by marijuana (17%), methamphetamine (4%), cocaine (2%), heroin (2%), prescription opioids, (1%), and inhalants (1%). The highest ranked substances other than alcohol and methamphetamine were marijuana (59%), cocaine (15%), prescription opioids (14%), heroin (7%), and inhalants (5%). INTRODUCTION Data indicate elevated rates of substance use among American Indians and Alaska Natives (AIAN) compared with other racial/ethnic groups (Office of Applied Studies, 2007). Analysis of cross-sectional data from the National Longitudinal Study of Adolescent Health (N=14,332; 18-26 y/o) showed that 12.8% of Native American youth had used meth in the past year (compared to 3.3% White, 0.6% Black, 1.9% Hispanic, and 1.8% Asian) (Iritani et al. 2007). To learn more about perceptions of methamphetamine use in Indian Country, 5 Nodes of the NIDA Clinical Trials Network are conducting a mixed-methods study using focus groups, quantitative clinical data, and surveys across many American Indian and Alaska Native communities in the western United States. Here we describe results of a telephone survey of community agency staff in the Four-Corners region regarding methamphetamine and other drug use. METHODS Participants were recruited from staff of community service agencies throughout New Mexico, Eastern Arizona, Southern Utah and Southern Colorado were asked to participate in a phone survey regarding their perceptions of Native American methamphetamine and other drug use, correlates and consequences. The 15-minute structured questionnaire contained questions that were both quantitative and qualitative in nature, using both Likert-type questions (e.g., how much of a problem is methamphetamine for Native Americans in your community) and open-ended questions (e.g., describe some of the problems you have seen related to methamphetamine use in your community. *Significance testing used Wilcoxon signed ranks test. **Drug #1 = highest ranked substance other than alcohol and methamphetamine. SUMMARY Results of this study must be interpreted with caution due to limitations including convenience sampling, limited sample size, use of a survey instrument that has not been validated, and reliance on participant perceptions rather than objective measures of the problems surveyed. With these limitations in mind, the study presents convincing evidence that alcohol is perceived as the most problematic substance by far for Native Americans in the Four-Corners region. Marijuana ranked second, followed by methamphetamine, cocaine, opioids, and inhalants. Methamphetamine is perceived as causing fewer problems and being less available than the leading drug other than alcohol and methamphetamine (most often marijuana). Overall, these findings are somewhat encouraging regarding the severity of meth-related problems in this region, although there is a suggestion that regional differences may exist, with more severe problems in some areas. These findings require confirmation through more objective indices of methamphetamine use before firm conclusions can be drawn. These ranks were significantly different from each other (p < .0005, Friedman’s two-way analysis of variance by ranks). Alcohol ranked higher than each other substance in pairwise comparisons (Wilcoxon signed ranks test, all p < .0005). Marijuana ranked significantly higher than methamphetamine ( p = .013), and methamphetamine ranked higher than cocaine ( p = .039), prescription opioids (p < .0005), heroin (p < .0005), and inhalants (p < .0005). RESULTS 100 participants were recruited from 100 community agencies in Arizona, Colorado, New Mexico, and Utah. Problems related to methamphetamine vs. highest ranked other drug Six items in the survey queried problems in the community related to methamphetamine and other drugs. Ratings for methamphetamine and the highest ranked substance other than alcohol and methamphetamine (defined above) are shown in the next column. Methamphetamine was rated as less problematic and less available than the #1 drug. REFERENCES Regional variability Finally, we compared ratings for the 6 methamphetamine questions in the table above among the six county groups in order to detect any differences by region in the perception of problems related to methamphetamine (Kruskal-Wallis test). Two of the six items showed significant regional variability at the nominal p = .05 level. Perceptions of local methamphetamine production and meth-related violent crime varied significantly by region (p = .012, p = .048, respectively). Although these differences would not survive protection for multiple comparisons, some of the observed effect sizes were large, e.g. d = 1.39 between region 2 (high) and region 4 (low) with respect to perceived local meth production, d = .97 between region 1 (high) and region 3 (low) with respect to perceived meth-related violent crime. Iritani, B.J. Hallfors, D.D. & Bauer, D.J. (2007). Crystal methamphetamine use among young adults in the USA. Addiction, 102, 1102-1113 Office of Applied Studies (2007). Substance use and substance use disorders among American Indians and Alaska Natives. the NSDUH report. Agency Distribution UT Group 1 – San Juan (Utah), Coconino, Apache, Navajo Group 2 – Montezuma, La Plata, Archuleta Group 3 – San Juan (NM), Rio Arriba, Los Alamos, Santa Fe, Sandoval Group 4 – Taos, Colfax, Union, Guadalupe Group 5 – Socorro, Lincoln, Otero, Chaves, Lea Group 6 – McKinley, Cibola, Valencia, Bernalillo CO ACKNOWLEDGEMENTS This research was supported by NIDA’s Clinical Trials Network We are grateful for the support of the Navajo Nation Human Research Review Board. AZ NM