Elsevier

Drug and Alcohol Dependence

Volume 226, 1 September 2021, 108841
Drug and Alcohol Dependence

Associations of prescription stimulant misuse with subsequent methamphetamine use among a U.S. cohort of HIV-vulnerable sexual and gender minorities who have sex with men

https://doi.org/10.1016/j.drugalcdep.2021.108841Get rights and content

Highlights

  • Sizable proportions of prescription stimulant misuse among HIV-vulnerable persons.

  • Many participants reported methamphetamine use.

  • 3% reported concurrent prescription stimulant misuse and methamphetamine use.

  • Increased odds of later methamphetamine use among prescription stimulant misusers.

Abstract

Introduction

Prescription stimulants and methamphetamine have similarities in chemical structure and impact on biological functioning. However, there is limited literature on prescription stimulant misuse among sexual and gender minorities as well as how prescription misuse may impact later methamphetamine use.

Methods

We used data collected from a HIV prevention cohort to describe (e.g., frequencies, percentages) prescription stimulant use/misuse and methamphetamine use at baseline and 12-month follow-up (n = 4857). We then used multivariable logistic regression models to determine the impact of baseline prescription stimulant misuse and methamphetamine use on 12-month prescription stimulant misuse and methamphetamine use.

Results

At baseline, 10.2 % of participants misused prescription stimulants and 12 % of participants used methamphetamine in the past 3 months, while at 12-month follow-up 11.6 % of participants misused prescription stimulants and 11.2 % of participants used methamphetamine in the past 3 months. Multivariable regression analyses indicated that participants who misused prescription stimulants (in the absence of methamphetamine) at baseline had 2.51 (95 % CI: 1.44–3.59, ref. no stimulant or methamphetamine use) times the odds of using methamphetamine at 12-month follow-up.

Discussion

Findings suggest that prescription stimulant use is a risk factor for continued meth use. Therefore, earlier and targeted public health interventions could reduce methamphetamine use by disrupting the progression from prescription stimulant misuse to methamphetamine use through early screening and interventions for prescription stimulant misuse.

Introduction

Stimulant misuse in the United States (U.S.) is not limited to methamphetamine use, but also includes misuse of other stimulants including prescription stimulants. Nationally, approximately 6.6 % of the U.S. population reported using prescription stimulants between 2015–2016 (Diller, 2019). Of those, 1.9 %, or 5 million people, reported misusing prescription stimulants (Diller, 2019). Prescription stimulant use is most prevalent among young populations especially college-aged youth (18–25) with use declining after the mid-thirties (Gerlach et al., 2014). Thus, most of the research regarding the use and misuse of prescription stimulants are in college or college-aged populations.

Most prescription stimulants users reported initiation during college (Bavarian et al., 2013). There are medically necessary reasons to take prescriptions stimulants, for example having a diagnosis of attention deficit hyperactivity disorder (ADHD) and, often, ADHD co-occurs with substance misuse in young people and adults (Young and Sedgwick, 2015). This study will focus on prescription stimulant misuse—including using prescription stimulants without a prescription or not as prescribed—which is noted as being common among college students (McCabe et al., 2018) and young people (Kroutil et al., 2006; Wu et al., 2007). Bavarian et al. (2013) found that a quarter of college students reported misusing prescription stimulants. Among young people, having friends who misused prescription stimulants was associated with their own misuse of prescription stimulants (Meisel and Goodie, 2015; Weyandt et al., 2009). Beyond medical necessity, there are other reasons that college-aged persons may misuse prescription stimulants including enhancing academic performance, weight loss, to counteract other used alcohol or substances, and to increase alertness or ability to concentrate (Bavarian et al., 2013; Blevins et al., 2017; Diller, 2019; Gibbs et al., 2016; Weyandt et al., 2016). Further, prescription stimulant misuse has been associated with psychological risk factors among young people such as depression, stress, and anxiety (Blevins et al., 2017; Dussault and Weyandt, 2013; Weyandt et al., 2016, 2009). Many young people who report misusing prescriptions stimulants report getting the medication from friends or family (Bavarian et al., 2013; Diller, 2019; McCabe et al., 2018), as well as from drug dealers or strangers (Diller, 2019).

Research has suggested that much of the stimulant misuse in the U.S., especially among young people, is not due to illicit stimulants such as methamphetamine but rather due to misuse of prescription stimulants (Kroutil et al., 2006). However, misuse of prescription and other illicit substances often coincide (Blevins et al., 2017; Lankenau et al., 2012). In fact, research has suggested that prescription stimulant misuse is higher among people with a history of other substance use (Weyandt et al., 2016). Misuse of prescription stimulants has been associated with higher proportions of study participants reporting past year alcohol, cannabis, cocaine, heroin, hallucinogen, inhalant, prescription sedative and prescription opioid use (Diller, 2019) though, again, this may be confounded by comorbidities leading to the prescribing of prescription stimulants (i.e. ADHD) (Young and Sedgwick, 2015). Methamphetamine is one illicit substance that is chemically similar and often concurrently used with prescription stimulants (Wu et al., 2007).

Methamphetamine, known colloquially as meth, crystal, tina, or ice, is an addictive and potent stimulant drug that may be smoked, snorted, injected, taken rectally (“booty bump”), or orally ingested (Bryant et al., 2018; Hammoud et al., 2020). When looking at Drug Enforcement Administration (DEA) classification resources, stimulants are broken down into two main categories: prescription and illicit (Drug Enforcement Administration Department of Justice, 2020). Prescription stimulants include amphetamines, methylphenidates, and other diet aids, while illicit stimulants include methamphetamine, cocaine, and methcathinone (Drug Enforcement Administration Department of Justice, 2020). Chemically, the prescription stimulant amphetamine and the illicit stimulant methamphetamine are similar and induce similar physiological and behavioral responses (National Institute on Drug Abuse, 2020; Goodwin et al., 2009; Kirkpatrick et al., 2012). In a study by Wu et al. (2007), they found that—among all simulant misusers—54 % only misused prescription stimulants and 22 % reported misusing both methamphetamine and prescription stimulants. In another study of concurrent prescription stimulant and methamphetamine use, adults had a higher prevalence of misusing methamphetamine and joint methamphetamine/prescription stimulant use compared to young people, and the prevalence of prescription stimulant misuse was similar among both adults and young people (Chen et al., 2014).

There is limited literature examining prescription stimulants misuse disparities among different populations; however, there is some indication of prevalent misuse among sexual minority (SM)-identified young people. Medley et al. (2016) found that 4.2 % of sexual minorities reported past year misuse of prescription stimulants compared to 1.9 % of persons who did not identify as a sexual minority (Medley et al., 2016). Another study among men who have sex with men (MSM) found that higher levels of stimulant misuse were associated with experiences of discrimination (Kecojevic et al., 2015). Although there is limited literature illuminating the extent of stimulant misuse among SMs, there is more literature highlighting the increasing problem of methamphetamine use among MSM. In the mid-2000s, a peak in methamphetamine use among MSM was met with significant public health response leading to a decline in methamphetamine use among MSM (Reback et al., 2008). However, in the years after this campaign, methamphetamine use has again rebounded (Pantalone et al., 2010), and, in recent years, has either remained stable or increased in MSM (Rivera et al., 2021; Ryan, 2021; United States Centers for Disease Control and Prevention, 2017). For example, in New York City in 2017, the estimated prevalence of methamphetamine use among MSM was 9.5 % (Rivera et al., 2021). Concerningly, methamphetamine has been associated with decreased inhibitions and sexual behaviors increasing vulnerability for HIV such as decreasing the use of condoms while increasing sexual libido (Baskin-Sommers and Sommers, 2006; Bryant et al., 2018; Green and Halkitis, 2006; Grov et al., 2020b; Halkitis et al., 2001; Hammoud et al., 2020; Knight et al., 2019).

There is little literature on prescription stimulant misuse and even less focusing on prescription stimulant misuse among persons identifying as sexual minorities. However, some research does suggest concurrent prescription stimulant misuse and methamphetamine use among populations. Given the increasing concern of methamphetamine among MSM and associations with HIV risk behavior, more information is needed to describe the misuse of prescription stimulants and potential concurrent use of methamphetamine among sexual and gender minorities (SGM). Therefore, this study aimed to describe prescription stimulant misuse among an HIV-vulnerable cohort of men, transgender (or trans) men, and trans women who have sex with men. Further, we sought to describe the concurrency of prescription stimulant misuse and methamphetamine use, as well as any association of previous prescription stimulant misuse with future methamphetamine use.

Section snippets

Enrollment

Data were taken from Together 5000 (T5K), a U.S. national, internet-based cohort study of men, transgender (trans) men, and trans women who have sex with men. The goal of T5K is to identify modifiable individual and structural factors associated with HIV seroconversion. Enrollment occurred between October 2017 and June 2018 using ads on men-for-men geosocial networking phone applications (apps). The cohort and study procedures have been fully described elsewhere (Grov et al., 2020a, 2019b; Nash

Results

At baseline, most participants were between 25−35 years old (52.1 %) and 18.2 % were 16−24 years old (Table 1). The majority of participants (97.7 %) identified as cisgender men and just over half (53.7 %) identified as white. Eighty-six percent of participants (85.5 %) identified as gay, queer, or homosexual and 11.5 % reported ever being in a same-sex marriage, civil union, or have had a commitment ceremony. Over half (63.8 %) reported having full-time employment, 40.7 % reported having a

Discussion

The aim of this paper was to describe prescription stimulant misuse and concurrency of prescription stimulant misuse and methamphetamine use among HIV-vulnerable men, trans men, and trans women. Further, we sought to determine if there was any association of prior prescription stimulant misuse with later methamphetamine use. Among study participants, we found substantial proportions of prescription stimulant misuse and methamphetamine use at baseline and 12-month follow-up. The three states

Conclusion

We found substantial prescription stimulant misuse and methamphetamine use at baseline and follow-up in a nationwide cohort of HIV-vulnerable men, trans men, and trans women. We also found substantial proportions of concurrent prescription stimulant misuse and methamphetamine use and that prior stimulant use is associated with later methamphetamine use. Our results indicate a potential intervention opportunity for reducing future illicit stimulant use by screening first for misuse of

Funding

Together 5,000 was funded by the National Institutes for Health (UH3 AI 133675 - PI Grov). D.A.W. was supported, in part, by a career development award (K01 AA 029047 - PI Westmoreland). Other forms of support include the CUNY Institute for Implementation Science in Population Health, the Einstein, Rock-efeller, CUNY Center for AIDS Research (ERC CFAR, P30 AI124414).

Contributors

DAW developed the analytic plan, oversaw analyses completion, interpreted the results, and led manuscript drafting; JG conducted the analyses and contributed to drafting the manuscript; AC assisted in results interpretation and manuscript development; and CG is the Principle Investigator for the Together 5,000 study who assisted in interpreting the results and contributed substantially to drafting and revising the manuscript.

Declaration of Competing Interest

The authors report no declarations of interest.

Acknowledgements

Special thanks to additional members of the T5K study team: Denis Nash, David Pantalone, Sarit A. Golub, Viraj V. Patel, Gregorio Millett, Don Hoover, Sarah Kulkarni, Matthew Stief, Chloe Mirzayi, Javier Lopez-Rios, Alexa D’Angelo, Pedro B. Carneiro, Fatima Sohra, & Michelle Dearolf. Thank you to the program staff at NIH: Gerald Sharp, Sonia Lee, and Michael Stirratt. And thank you to the members of our Scientific Advisory Board: Michael Camacho, Demetre Daskalakis, Sabina Hirshfield, Jeremiah

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