Special Report Iowa Injection Drug Use Admissions to Treatment: 2000 to 2014

Transcription

1 Special Report Iowa Injection Drug Use Admissions to Treatment: 2000 to 2014 THE IOWA CONSORTIUM FOR SUBSTANCE ABUSE RESEARCH AND EVALUATION Injection Drug Use at Treatment Admission in Iowa With Funds Provided By: Iowa Consortium for Substance Abuse Research and Evaluation University of Iowa 2018 The University of Iowa

2 Special Report Iowa Injection Drug Use Admissions 2000 to 2014 Stephan Arndt, PhD DeShauna Jones, PhD Suzy Hedden, BS Suggested Citation: Arndt, S., Jones, D., Hedden, S. (2018). Iowa Injection Drug Use Admissions: 2000 to Iowa City, IA: Iowa Consortium for Substance Abuse Research and Evaluation.

3 EXECUTIVE SUMMARY Iowa has seen increasing rates of HIV, hepatitis, and opioid related problems in the last several years. An obvious connection between these issues is injection drug use (IDU) and people who inject drugs (PWID). We looked at SAMSHA's Treatment Episode Dataset Admissions for the past 15 years of available data for Iowa treatment centers and focused on IDU admissions. There were 422,119 admissions between 2000 and 2014 in Iowa with records in the dataset. Major findings: The percentages of IDU admissions have nearly doubled between 2008 and 2014 after showing a decline between 2004 and The sex, race, and ethnicity of IDU cases have remained fairly stable over the 15 year period. The largest growing age group of IDU admissions and PWID was aged Although small in number, those aged 50 or above showed the most proportional increase, 5.2 times over the 15 years - from 9 new IDU clients in 2000 to 47 new IDU clients in Admissions indicating that the client was unemployed showed the largest increase over time. Surprisingly, and unlike the nation as a whole, Iowa's IDU cases primarily injected methamphetamine, not opioids. The reduced admissions for IDU between 2004 and 2008 was due to reduced methamphetamine admissions. The recent increase in IDU is mainly due to increased methamphetamine admissions between 2008 and 2014, although opioids have also shown an increase. i

4 TABLE OF CONTENTS Background... 1 Overview... 1 Data... 1 Trends in Injection Drug use... 1 Number of Injection and Non-injection Admissions... 1 Figure 1: Percent All Admissions and New Clients Reporting IDU... 2 Basic Demographic Changes... 2 Sex... 2 Figure 2: Number of Admissions reporting IDU by Sex Figure 3: Number of Admissions Reporting IDU by Race/Ethnicity Age... 4 Figure 4: Percent IDU and Non-IDU Admissions by Age... 4 Figure 5: Number of Admissions Reporting IDU by Age Employment... 5 Figure 6: Number of Admissions Reporting IDU by Employment Status, Substance Related Changes... 6 Primary Injected Substance... 6 Figure 7: Percent of Admissions by Primary Substance IDU: US versus Iowa... 7 Figure 8: Percent of Admissions Reporting IDU by Primary Substance Figure 9: Frequency of IDU by Type of Drug... 9 Table 1: Frequency of IDU by Type of Drug... 9 Summary...10

5 BACKGROUND Overview Recent concerns over increased opioid use has also drawn attention to injection drug use. In addition to issues surrounding substance use, injection drug use (IDU) raises worry about communicable diseases such as HIV and hepatitis. In fact, Iowa has seen increasing HIV and hepatitis rates. 1 For both HIV and hepatitis, Iowa is showing an all-time high number of new cases for these diseases. Although there may be many factors spurring the increases, IDU is one source of transmission and new infection. This report focuses on IDU from 2000 to Different drugs can be injected, such as opioids and stimulants, however, the transmission of HIV and other problems associated with injections are not dependent on the type of drug used. Data The combined public use files from Treatment Episodes Dataset Admission series from 2000 to 2014 provided the data used for this report. These datasets represent all admissions to treatment centers that receive any public money. Iowa records indicating whether there was IDU or not are included (n = 422,119). Of special note, the data for this report pertains to admissions rather than clients, since clients can have more than one admission in the period, reflecting relapses or transfers to a different treatment agency. Some client-based analyses allowed only one admission per client. Analyses including clients first admission only are labeled client while analyses including all client admissions are labeled admissions. Where appropriate, the correct statistical analyses were used to reflect possible multiple admissions by the same clients. TRENDS IN INJECTION DRUG USE Number of Injection and Non-injection Admissions Figure 1 shows the percent of all admissions and the percent of all new clients going to treatment who indicated IDU. Averaged over all years, IDU was reported in 7.4% of admissions and 5.3% injected their primary problem substance. For both admissions and new clients, the percentages were increasing from 2000 to 2004 but then showed a decline until The more recent trend since 2008 has shown a general yearly increase. The percentages have nearly doubled between 2008 and Iowa Department of Public Health Bureau of HIV, STD, and Hepatitis 2016 HIV Disease End-of-Year Surveillance Report, May 8, Iowa Department of Public Health Bureau of HIV, STD, and Hepatitis 2016 Hepatitis C Virus (HCV) End-of-Year Surveillance Report: November, Iowa Injection Drug Use

6 Figure 1: Percent All Admissions and New Clients Reporting IDU Percent Admissions and Clients Injecting Drugs 12% 10% 8% 6% 4% 2% Admissions New Clients 0% The difference between the new clients and the total admissions is due to multiple admissions for the same client. For example, nearly 17% of admissions indicating IDU also indicate five or more prior admissions to treatment. In contrast, less than 7% of non-injection admissions report five or more prior admissions. Both the number of admissions and the number of new clients increased between 2008 and Basic Demographic Changes Sex Client sex has not shown a trend over the years in IDU admissions. Figure 2 shows the changes over time in both male and female admissions. Females make up approximately 40% of all admissions indicating IDU. This has varied only slightly from 37.3% in 2000 to 45.5% in Iowa Injection Drug Use

7 Number of Admissions Number of Admissions Figure 2: Number of Admissions reporting IDU by Sex Male / Female Injection Admissions 2,000 Male Female 1,500 1, Figure 3 shows the stability of race/ethnicity of IDU over time. Whites have consistently made up between 91% and 93.8% of all injection drug admissions averaged over the period. Blacks account for 1.9%, Latinos 2.8%, and Other account for 2.6%. The exception is admissions indicating Black race fell more than half, from 3% in 2000 to 1.3% in Figure 3: Number of Admissions Reporting IDU by Race/Ethnicity Race/Ethnicity for Injection Admissions White Black Latino Other 3,500 3,000 2,500 2,000 1,500 1, Iowa Injection Drug Use

8 Age Averaged over all years, those admissions indicating injection drug/substance use appear concentrated among 25 to 39 year olds as compared to the non-injecting admissions. As might be expected there are far fewer very young injection admissions. Figure 4: Percent IDU and Non-IDU Admissions by Age Age of Non-Injection and Injection Admissions 25% Non-Injection Injection 20% 15% 10% 5% 0% < Age Over time, there have been shifts in the ages of IDU admissions as shown in Figure 5. Those in their 20s and 30s have increased the most. Admissions in their 20s have increased nearly two and a half times; those in their 30s have nearly doubled. Of note, although they are a small group, those in their fifties and older have increased over seven times during this period, from 27 IDU admissions in 2000 to 201 admissions in Iowa Injection Drug Use

9 Number of Admissions Figure 5: Number of Admissions Reporting IDU by Age Age Groups for Injection Admissions <= ,000 2,500 2,000 1,500 1, This pattern of change by age group is roughly consistent when considering individual clients who indicated no previous admissions. For this subset, the largest growing group was aged in terms of numbers of clients. Similarly, those aged 50 or above showed the most proportional increase, 5.2 times, from 9 new IDU clients in 2000 to 47 new IDU clients in Employment Admissions indicating that the client was unemployed has shown the largest increase over time as seen in Figure 6. Other groups have maintained or only increased slightly. Iowa Injection Drug Use

10 Number of Admissions Figure 6: Number of Admissions Reporting IDU by Employment Status, Employment of Injection Admissions Full Time Part Time Unemployed Not in Labor Force Substance Related Changes Primary Injected Substance Over all years, 22,545 Iowa admissions indicated that they injected their primary problem substance. Cocaine, heroin, other opioids, and methamphetamine combined accounted for over 95% of all primary substances that were injected. Surprisingly, unlike the rest of the nation, Iowa's IDU problem is very different as seen in Figure 7. Heroin and other opioids make up 24% of all IDU admissions while methamphetamine accounts for approximately 70% of IDU admissions. In contrast, for the US as a whole, opioids make up 85% of the IDU cases (heroin 79% and other opioids 6%), while methamphetamine only accounts for 11%. These figures are similar considering any injected drug, primary, secondary, or tertiary problem substance. Iowa Injection Drug Use

11 Percent Injected Drug Figure 7: Percent of Admissions by Primary Substance IDU: US versus Iowa 90% 80% 70% US vs Iowa Injection Drugs 60% 50% 40% 30% 20% 10% 0% Methamphetam Cocaine/Crack Heroin Other Opioids Other ine US 3% 78% 6% 11% 2% Iowa 4% 13% 11% 69% 2% Figure 8 shows the substance change over time and indicates the drivers for the increased IDU admissions. While opioids are contributors, the primary driving substance is methamphetamine. Iowa Injection Drug Use

12 Number of New Casses Figure 8: Percent of Admissions Reporting IDU by Primary Substance ,500 IDU Primary Substances in Iowa 2,000 1,500 1, Other Cocaine/Crack Other Opioids Heroin Methamphetamine The majority of IDU admissions reported injecting their primary problem substance (62.5%) while another 18.2% injected their secondary problem substance. Just under 10% (9.9%) injected both primary and secondary substances. The remainder of the IDU admissions only injected their tertiary substance. Of those who injected their secondary substance, the most often reported substance was again methamphetamine. The next most frequent injected secondary substance was cocaine (18.8%) followed by other opioids (11.7%), and then heroin (11.4%). Of those who injected their tertiary problem substance, the pattern was the same with methamphetamine (47.7%), cocaine (26.1%), heroin (12.9%), and other opioids (8.2%). Frequency of use differed by substance. Using only new cases to represent individuals, there were significant differences in use frequency between clients injecting cocaine, heroin, other opioids, methamphetamine, or other substances. 2 Table 1 shows the percentages of use frequency for each injected primary problem substance. Heroin and other opioids tended to be injected daily. Other substances tended to be injected more infrequently. 2 Kruskal-Wallis χ 2 = , df = 4, p < Iowa Injection Drug Use

13 Figure 9: Frequency of IDU by Type of Drug Type of Drug and Frequency of IDU Cocaine/Crack Heroin Other Opioids Methamphetamine Other 70% 60% 50% 40% 30% 20% 10% 0% No use past 6 months 3 times past week 2 times past week 6 times past week Daily Source of referral differed significantly among the different types of drugs injected as a primary substance. 3 Table 1 shows the percent of individuals using different primary substances for IDU and the source of their referral. Criminal justice referrals were highest for methamphetamine and cocaine/crack. Heroin and other opioid clients were most often referred by another individual or referred themselves. Table 1: Frequency of IDU by Type of Drug Referral Source Cocaine / Crack Heroin Other Opioids Methamphetamine Other Individual/Self 38% 48% 45% 23% 38% SUD Care Provider 9% 12% 12% 15% 15% Other Health Care 11% 12% 14% 8% 13% School 0% 0% 0% 0% 0% Employer 1% 0% 4% 1% 2% Other Community Agency 6% 3% 5% 9% 4% Criminal Justice 35% 25% 21% 44% 28% 3 χ 2 = , df = 24, p < Iowa Injection Drug Use

14 In reviewing the pattern of referrals over time for methamphetamine, the relative percents from each referral source have remained somewhat consistent. The dip in IDU cases during the 2004 to 2008 period was reflected in reduced referrals from all sources and not just criminal justice. Summary Iowa has seen an increased rate of IDU over the last 15 years. From 2004 to 2008, there was an initial reduction in IDU but since 2008, the state has seen a nearly constant increase since then. While the recent increase is, in part due to increasing opioids, the primary driver of the increase is injected methamphetamine. Unlike the US as a total, Iowa's IDU issue is principally methamphetamine. While some demographics (sex and race) have remained relatively constant over the period, the increase seems larges in those aged in their twenties and thirties. Older admissions, although infrequent, have seen a large proportional increase although the group. IDU also appears to be increasing among the unemployed. Major findings: The percentages of IDU admissions have nearly doubled between 2008 and 2014 after showing a decline between 2004 and The sex, race, and ethnicity of IDU cases have remained fairly stable over the 15 year period. The largest growing age group of IDU admissions and PWID was aged Although small in number, those aged 50 or above showed the most proportional increase, 5.2 times over the 15 years - from 9 new IDU clients in 2000 to 47 new IDU clients in Admissions indicating that the client was unemployed showed the largest increase over time. Surprisingly, and unlike the nation as a whole, Iowa's IDU cases primarily injected methamphetamine, not opioids. The reduced admissions for IDU between 2004 and 2008 was due to reduced methamphetamine admissions. The recent increase in IDU is mainly due to increased methamphetamine admissions between 2008 and 2014, although opioids have also shown an increase. Suggested evidence based practices: Syringe Services Programs (SSPs). Increase Medication Assisted Treatment (MAT) availability and acceptability. Research and development efforts to create MAT for Methamphetamine Use Disorder. Investigate allowing "safe injections sites" to reduce overdose deaths and infection transmission as well as increase contact with health and treatment professionals. Iowa Injection Drug Use