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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.
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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?
Methods • Three waves of cross sectional studies conducted at shelters and free meal programs in San Francisco Wave 1: 1996-1997 ------------- Wave 2: 1999-2000 --------------- Wave 3: 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 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
MA trends by HIV status (n=60)
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, PhD Assistant Professor EPI Center, Department of Medicine UCSF San Francisco, CA 94143-1372 Jhahn@epi-center.ucsf.edu