Behavioral and Health Outcome Differences by Heroin or Methamphetamine Preference Among People in Rural US Communities Who Use Both Substances.
L Sarah Mixson, Bridget M Whitney, Wiley D Jenkins, Thomas J Stopka, P Todd Korthuis, Lydia N Drumright, Stephanie A Ruderman, Peter D Friedmann, Mai T Pho, April M Young, Ryan P Westergaard, David W Seal, Vivian F Go, William C Miller, William A Zule, Judith Feinberg, Hannah Lf Cooper, Judith I Tsui, Heidi M Crane, Joseph A Delaney
Author Information
L Sarah Mixson: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. ORCID
Bridget M Whitney: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Wiley D Jenkins: Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.
Thomas J Stopka: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
P Todd Korthuis: Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Lydia N Drumright: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Stephanie A Ruderman: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Peter D Friedmann: Office of Research, UMass Chan Medical School - Baystate and Baystate Health, Springfield, MA, USA.
Mai T Pho: Biological Sciences Division, University of Chicago, Chicago, IL, USA.
April M Young: Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
Ryan P Westergaard: Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.
David W Seal: Department of Social, Behavioral, and Population Science Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Vivian F Go: Department of Health Behavior, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
William C Miller: Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, US.
William A Zule: Division of Behavioral Health and Criminal Justice Research, RTI International, Research Triangle Park, NC, USA.
Judith Feinberg: Department of Medicine, West Virginia University, Morgantown, WV, USA.
Hannah Lf Cooper: Department of Behavioral, Social, and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Judith I Tsui: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Heidi M Crane: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Joseph A Delaney: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Background: The United States' (US) opioid overdose epidemic has evolved into a combined stimulant/opioid epidemic, a pattern driven in part by mitigating opioid overdose risk, variable substance availability, and personal preferences. This study aimed to investigate the association between self-reported substance preference (heroin or methamphetamine) and behavioral/health outcomes among individuals who used both heroin and methamphetamine in the rural US. Methods: The Rural Opioid Initiative is a consortium of 8 research cohorts from 10 states and 65 rural counties that recruited individuals reporting past 30-day injection of any substance or opioid substance use by any route from 1/2018 to 3/2020. Analyses were restricted to participants ⩾18 years, who self-reported either heroin or methamphetamine as their preferred substance and past 30-day use of both heroin and methamphetamine. We examined cross-sectional associations between preferred substance (heroin versus methamphetamine) and behavioral and health outcomes using random effects meta-analysis with adjusted regression models. Results: Among 1239 participants, 61% (n = 752) reported heroin as their preferred substance. Adjusting for age, sex, and race/ethnicity, methamphetamine preference was associated with lower prevalence ratios for current naloxone possession (adjusted prevalence ratio [aPR] = 0.68; 95% Confidence Interval [95% CI] = 0.59-0.78; -value ⩽ .001), of ever being told they had the hepatitis C virus (HCV; aPR = 0.72; 95% CI: 0.61-0.85; -value ⩽ .001) and a personal history of overdose (aPR = 0.81; 95% CI = 0.73-0.90; -value ⩽ .001). Conclusion: In our study analyzing associations between preferred substance and various behavioral and health outcomes amongst people who use both heroin and methamphetamine, a majority of participants preferred heroin. Methamphetamine preference was associated with lower prevalence of naloxone possession, ever being told they had HCV, and prior history of an overdose. This study underscores the need for targeted harm reduction services for people who prefer methamphetamine in rural areas.
