Crystal methamphetamine initiation among street-involved youth

Abstract

Background Although many settings have recently documented a substantial increase in the use of methamphetamine-type stimulants, recent reviews have underscored the dearth of prospective studies that have examined risk factors associated with the initiation of crystal methamphetamine use. Objectives Our objectives were to examine rates and risk factors for the initiation of crystal methamphetamine use in a cohort of street-involved youth. Methods Street-involved youth in Vancouver, Canada, were enrolled in a prospective cohort known as the At-Risk Youth Study (ARYS). A total of 205 crystal methamphetamine-naïve participants were assessed semi-annually and Cox regression analyses were used to identify factors independently associated with the initiation of crystal methamphetamine use. Results Among 205 youth prospectively followed from 2005 to 2012, the incidence density of crystal methamphetamine initiation was 12.2 per 100 person years. In Cox regression analyses, initiation of crystal methamphetamine use was independently associated with previous crack cocaine use (adjusted relative hazard [ARH] = 2.24 [95% CI: 1.20–4.20]) and recent drug dealing (ARH = 1.98 [95% CI: 1.05–3.71]). Those initiating methamphetamine were also more likely to report a recent nonfatal overdose (ARH = 3.63 [95% CI: 1.65–7.98]) and to be male (ARH = 2.12 [95% CI: 1.06–4.25]). Conclusions We identified high rates of crystal methamphetamine initiation among this population. Males those involved in the drug trade, and those who used crack cocaine were more likely to initiate crystal methamphetamine use. Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.

Homelessness and incarceration associated with relapse into stimulant and opioid use among youth who are street‐involved in Vancouver, Canada

“…Previous studies using data from the same cohort have found high rates of crystal methamphetamine use , and in the current study, daily crack and daily crystal methamphetamine use accounted for a large proportion of baseline‐reported stimulant use. The cheap and easy access to crystal methamphetamine has been suggested to be a driver in the high rates of usage in this population .…”

“…The cheap and easy access to crystal methamphetamine has been suggested to be a driver in the high rates of usage in this population . Among youth and adult populations of PWUD, crystal methamphetamine and crack cocaine use have also been found to be associated with a higher risk profile, including risky sexual practices and HIV incidence . Taken together, it is unclear if factors that may pre‐dispose individuals to use stimulants play a role in increased risk of relapse or if characteristics of stimulant drugs and the absence of pharmacotherapy treatment modalities for stimulant dependence primarily account for this observed relationship.…”

The relationship between violence and engagement in drug dealing and sex work among street-involved youth

“…While many people who use drugs are known to engage in drug dealing to sustain their drug use, 19,20 for some individuals, drug market involvement preceded the initiation of illicit drug use, which may be the case for some street-involved youth. 12,21 Among street-involved youth engaging in drug dealing in this setting, the majority (79%) have been shown to assume a role of a direct drug seller, followed by a “middler” (i.e., coordinating a deal between a dealer and client) (28%) and a “holder” (i.e., carrying drugs during a drug trade) (6%). 19 All these roles operate at the lowest end of the drug market hierarchy and thereby increase vulnerability to violence, including encounters with violent customers or police officers, and the risk of being punished when unable to fulfill assigned quotas.…”

“…As in a previous study, sex work was defined as having exchanged sex for gifts, food, clothing, shelter, money or drugs. 12 …”

Longitudinal patterns of amphetamine use from adolescence to adulthood: A latent class analysis of a 20-year prospective study of Australians

“…Longitudinal research on adolescent antecedents of amphetamine use among adolescents and young adult is very limited. Most research is based on cross-sectional data, with study participants derived primarily from high-risk populations such as adult drug users (e.g., Quinn et al, 2013), or street-involved young people (e.g., Uhlmann et al, 2014). Findings from these studies have limited generalizability to the broader population, and the cross-sectional studies (e.g., Chen et al, 2014) Identification of key adolescent markers of regular use potentially provides important information for prevention and intervention programs to target high-risk adolescents at an earlier stage, reducing their risks of progressing to regular use and dependence.…”