Racial and ethnic changes in heroin injection in the United States: Implications for the HIV/AIDS epidemic
Section snippets
Background
Racial/ethnic disparities in HIV infection in the United States are greatest in cases attributed to drug injection. In 2005, non-Hispanic (NH) Blacks and Hispanics, respectively, constituted 55 and 23% of such cases but only 12 and 15% of the US population (CDC, 2006a, CDC, 2006b, US Census Bureau, 2005). A recent study of 94 US metropolitan areas found that the elevated AIDS case rates for NH-Blacks compared to NH-Whites were correlated with higher drug injection rates among NH-Blacks (Cooper
Data sources
To describe patterns in the mode of heroin administration among different demographic groups between 1992 and 2004, we analyzed 3 data sources. The public Treatment Episode Data Set (TEDS) reports data from 50 states and Puerto Rico regarding the approximately 1.9 million annual admissions to public and private substance abuse treatment programs that receive state funds (SAMHSA, 2006). TEDS does not include data from facilities operated by the Federal Bureau of Prisons, the Department of
TEDS data: 1992–2004
Race/ethnicity, gender, and referral sources at admission to publicly funded drug treatment programs were largely stable between 1992 and 2004, but the proportion of admissions age 40 years and older increased from 21.6 to 34.6%. The largest changes in primary substance of abuse were for marijuana/hashish (from 6.1 to 15.9%) and methamphetamine (from 1.0 to 7.0%). The prevalence of drug injection among all admissions remained nearly constant from 1992 to 2004 (range 13.1–14.0%). However, the
Discussion
This study examined national substance abuse treatment data (TEDS) and two research studies, one of young injection drug users (CIDUS-III) and one of young noninjecting heroin users (NIHU-HIT). A striking finding in our analysis is the substantial decline in young NH-Black heroin injectors entering treatment and enrolling in research studies. As an example of the latter, NH-Blacks were only 12% of Baltimore's CIDUS-III sample despite constituting 64% of the city's population (US Census Bureau,
Role of funding source
While conducting this research, D. Broz was supported by a Predoctoral Prevention Research Training Program Fellowship sponsored by the National Institute on Drug Abuse (NIDA), and before that by NIDA grant R01 DA12068, Noninjected Heroin Use, HIV and Injection Transitions Study (NIHU-HIT). L.J. Ouellet was also supported by NIDA (grant R01 DA12068, NIHU-HIT Study) and by the Centers for Disease Control and Prevention (CDC) (grant, U64/CCU517656, Collaborative Injection Drug User Studies III
Conflict of interest
D. Broz and L.J. Ouellet have no conflicts of interest, including specific financial interest, relationship, and affiliation relevant to the subject matter discussed in the manuscript, that could inappropriately influence, or be perceived to influence, their work.
Acknowledgments
We thank the CIDUS-III Study Group, which includes the following people: Steffanie Strathdee, Elizabeth Golub, Marie Bailey-Kloch, Karen Yen-Hobelman (Baltimore); Lawrence Ouellet, Susan Bailey, Joyce Fitzgerald (Chicago); Sharon Hudson, Peter Kerndt, Karla Wagner (Los Angeles); Mary Latka, David Vlahov, Farzana Kapadia (New York); Holly Hagan, Hanne Thiede, Nadine Snyder, Jennifer V. Campbell (Seattle); Richard Garfein, David Purcell, Ian Williams, Paige Ingram, Andrea Swartzendruber (CDC).
References (86)
- et al.
Quality of treatment data. Reliability over time of self-reports given by clients in treatment for substance abuse
J. Subst. Abuse. Treat.
(1996) - et al.
Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young injection drug users in 5 U.S. cities
Drug Alcohol Depend.
(2007) - et al.
Peginterferon and ribavirin treatment in African American and Caucasian American patients with hepatitis C genotype 1
Gastroenterology
(2006) - et al.
Racial/ethnic disparities in injection drug use in large US metropolitan areas
Ann. Epidemiol.
(2005) - et al.
High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study
Drug Alcohol Depend.
(2002) - et al.
Methods to recruit and retain a cohort of young-adult injection drug users for the Third Collaborative Injection Drug Users Study/Drug Users Intervention Trial (CIDUS III/DUIT)
Drug Alcohol Depend.
(2007) - et al.
Correlates of attempted suicide among young injection drug users in a multi-site cohort
Drug Alcohol Depend.
(2004) - et al.
Effects of drug treatment for heroin sniffers: a protective factor against moving to injection?
Soc. Sci. Med.
(2004) - et al.
First injection of ketamine among young injection drug users (IDUs) in three U.S. cities
Drug Alcohol Depend.
(2007) - et al.
Viral dynamics and response differences in HCV-infected African American and white patients treated with IFN and ribavirin
Hepatology
(2003)
Hepatitis C virus genotypes and viral concentrations in participants of a general population survey in the United States
Gastroenterology
Circumstances surrounding the first injection experience and their association with future syringe sharing behaviors in young urban injection drug users
Drug Alcohol Depend.
Injection drug use in North America
Infect. Dis. Clin. North Am.
Assessing consistency of responses to questions on cocaine use
Addiction
A heroin epidemic at the intersection of histories: the 1960s epidemic among African Americans in Baltimore
Med. Anthropol.
Explaining drug use trends: suburban heroin use in Baltimore County
Open marginality: heroin epidemics in different groups
J. Drug Issues
Injection drug users in the United States, 1979–2002: an aging population
Arch. Intern. Med.
The prevalence of hepatitis C virus infection in the United States, 1999 through 2002
Ann. Intern. Med.
Admissions of narcotic drug addicts to public health service hospitals, 1935–63
Public Health Rep.
Statistical inference for apparent populations
Sociol. Methodol.
Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach
PloS. Med.
What happened in Harlem? Analysis of a decline in heroin use among a generation unit of urban Black youth
J. Drug Issues
Licit and Illicit Drugs
Epidemiology of HIV/AIDS—United States, 1981–2006
MMWR Morb. Mortal Wkly. Rep.
The initiation of the use of heroin in the age of crack
Young men and drugs in Manhattan: a causal analysis
NIDA Res. Monogr.
Dark Paradise: Opiate Addiction in America Before 1940
Opium Addiction in Chicago
Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City
J. Acquir. Immune. Defic. Syndr. Hum. Retrovirol.
The dynamics of a heroin addiction epidemic
Science
Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study)
J. Urban Health
An overview of heroin trends in New York City: past, present and future
Mt. Sinai. J. Med.
Similarities and differences by race/ethnicity in changes of HIV seroprevalence and related behaviors among drug injectors in New York City, 1991–1996
J. Acquir. Immune. Defic. Syndr.
Factors associated with adolescent initiation of injection drug use
Public Health Rep.
Prevalence and incidence of hepatitis C infection among young adult injection drug users
J. Acquir. Immune. Defic. Syndr.
A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users
AIDS
The incidence of illicit drug use in the United States, 1962–1989
Br. J. Addict.
Audio computer assisted self-interview and face to face interview modes in assessing response bias among STD clinic patients
Sex Transm. Infect.
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2016, Drug and Alcohol DependenceCitation Excerpt :This change is thought to be largely driven by the growing use and availability of prescription opioids during the late 1990s, and the subsequent migration of such prescription opiate users to heroin in search of lower costs and easier, less risky access (Cicero et al., 2007; Mars et al., 2014; Martins et al., 2015; Unick et al., 2013; Young and Havens, 2012). In addition, an escalation to intravenous heroin use seems to be expanding dramatically among the non-Hispanic whites below 50 years of age while the rates are declining among the blacks, most markedly in younger blacks (Armstrong, 2007; Broz and Ouellet, 2008; Cooper et al., 2008; SAMHSA, 2007, 2011; Siegal et al., 1994; Unick et al., 2013). It is thus not surprising that veterans receiving buprenorphine, the recently approved OAT treatment, nationally through VHA are significantly younger, and more likely to be white and living in rural areas compared to those receiving the older methadone treatment.
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