Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern
Open accessAbstract
OBJECTIVE: We sought to describe an emerging drug use pattern characterized by injection of both methamphetamine and heroin. We examined differences in drug injection patterns by demographics, injection behaviors, HIV and HCV status, and overdose. METHODS: Persons who inject drugs (PWID) were recruited as part of the National HIV Behavioral Surveillance (NHBS) system in Denver, Colorado. We used chi-square statistics to assess differences between those who reported only heroin injection, only methamphetamine injection, and combined heroin and methamphetamine injection. We used generalized linear models to estimate unadjusted and adjusted prevalence ratios to describe the association between drug injection pattern and reported nonfatal overdose in 2015. We also examined changes in the drug reported as most frequently injected across previous NHBS cycles from 2005, 2009, and 2012. RESULTS: Of 592 participants who completed the survey in 2015, 173 (29.2%) reported only injecting heroin, 123 (20.8%) reported only injecting methamphetamine, and 296 (50.0%) reported injecting both drugs during the past 12 months. Injecting both heroin and methamphetamine was associated with a 2.8 (95% confidence interval: 1.7, 4.5) fold increase in reported overdose in the past 12 months compared with only injecting heroin. The proportion of those reporting methamphetamine as the most frequently injected drug increased from 2.1% in 2005 to 29.6% in 2015 (p < 0.001). CONCLUSIONS: The rapid increase in methamphetamine injection, and the emergence of combining methamphetamine with heroin, may have serious public health implications.
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A meta-analysis showed a relationship between general substance use and risky sexual behaviors, such as unprotected sex and multiple partners, among adolescents.
“A meta-analysis showed a relationship between general substance use and risky sexual behaviors, such as unprotected sex and multiple partners among adolescents.174”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [174]
The Methods (Statistical analysis; page unavailable) describe an analysis of heroin and methamphetamine injection patterns and overdose, not a meta-analysis. Although the Methods (Study design and protocol; page unavailable) say the survey asked about sexual behaviors, no passage found reports an association between general substance use and unprotected sex or multiple partners among adolescents. Searches for the meta-analysis and those sexual-risk outcomes did not locate the claimed finding. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPeople who use stimulants have a higher prevalence of risky sexual behaviors.
“it is known that risky sexual behaviors are more prevalent in this population”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [174]
The Methods section says the survey asked about sexual behaviors, and the Results report one sexual-behavior measure for male participants. Neither passage compares risky sexual behavior among stimulant users with another population; the Discussion instead reports greater injection risk among people injecting both heroin and methamphetamine. No page numbers are available in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredDetecting STIs earlier is beneficial and lowers transmission.
“earlier identification of STIs is beneficial and reduces transmission.174”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [174]
The Methods describe HIV and HCV testing among people who inject drugs, and the Results report infection prevalence. Neither section addresses whether earlier identification of STIs is beneficial or reduces transmission; searches for early identification and STI screening found no passage making that point. Page numbers are unavailable in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measuredRisky sexual behaviors are more prevalent in individuals who use stimulants.
“As evidence suggests that risky sexual behaviors are more prevalent in individuals who use stimulants, clinicians should gather information from the patient about their sexual behaviors to properly determine psychosocial and harm reduction service needs.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [174]
The Methods (Study design and protocol; page unavailable) say the survey asked about sexual behaviors, but the passages found do not compare risky sexual behavior among stimulant users and others. The Discussion reports higher injection risk among people injecting both heroin and methamphetamine, which does not establish the claimed difference in sexual behavior. Searches for sexual risk, sexual behaviors, and sex partners found no such comparison in our copy. (LLM, conf=0.76)
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References 15 · Cited by 203
Research works printed but not linked: 2
- Denver Office of Drug Strategy 2015 Proceedings of the Denver Epidemiology Work Group, Spring 2015 report Retrieved from http://denverdrugstrategy-public.sharepoint.com/SiteAssets/Pages/Program-Data/DEWG%20Report%20Spring%202015.pdf
- National Institute on Drug Abuse 2014 Epidemiologic trends in drug abuse: Proceedings of the Community Epidemiology Work Group Retrieved from https://www.drugabuse.gov/sites/default/files/cewg_jan2014_execsumm.pdf
- Authors
- Al-Tayyib, A., Koester, S., Langegger, S., & Raville, L.
- Affiliations
- University of Colorado Denver (US)
- Akita International University (JP)
- ORCID
- Koester, Stephen
- Venue
- Substance Use & Misuse
- Publisher
- Informa UK Limited
- Published
- 2017-03-21
- Volume
- 52
- Issue
- 8
- Pages
- 1051-1058
- ISSN
- 1082-6084 (ISSN-L)
- 1532-2491
- PMC
- PMC5642954
- OpenAlex
- W2602887587
- Cited by
- 203
- References
- 15
- Citations by year
- 2026: 19 · 2025: 13 · 2024: 22 · 2023: 24 · 2022: 30 · 2021: 42 · 2020: 30 · 2019: 14 · 2018: 6 · 2017: 2
- FWCI
- 11.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Substance Use & Misuse (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Disease Control and Prevention (U1BPS003251)
- National Institute on Drug Abuse (K01DA036452)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- heroin injection, polydrug use, non-fatal overdose, people who inject drugs, HIV, hepatitis C, drug use trends
- MeSH terms
- Adolescent, Adult, Heroin, Female, Hepatitis C, Heroin Dependence, Humans, Male, Methamphetamine, Middle Aged, HIV Infections, Substance Abuse, Intravenous, Comorbidity, Prevalence, Amphetamine-Related Disorders, Young Adult
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