Substance Use
Trajectories and predictors of stimulant use among people who use drugs in the fentanyl era Leah Shaw* Seashore (Yu) Li Leah C. Shaw Katie B. Biello Scott E. Hadland Susan G. Sherman Brandon D.L. Marshall Julia E. Noguchi
Background: Identification of trajectories and predictors of stimulant use are needed to understand rapidly evolving substance use patterns in the fentanyl era.
Methods: We used data from the Rhode Island Prescription and Illicit Drug Study (RAPIDS) at baseline and 5 subsequent follow-up visits through 12 months. We constructed group-based trajectory models based on the maximum days of any stimulant use in the past month involving four classes of stimulants to identify patterns of drug use among a subgroup of people who use stimulants. Generalized estimating equations (GEE) models were used to identify predictors of trajectory membership.
Results: Of 505 participants analyzed, the median age was 43 (IQR:35-53), almost ⅔ were cis-male and half were non-Hispanic White. Mean days of past-month stimulant use reported at baseline were extra-medical prescription stimulants (3.4); crystal methamphetamine (4.3); powder cocaine (3.9); and crack cocaine (13.1). Trajectory modeling identified four distinct trajectories of any stimulant use: lowest (12%), low/moderate (52%), moderate/high (19%), and highest (17%); Mean days of crack cocaine use were consistently the highest across the four groups (1.9, 8.1, 18.2, 27.7). Figure 1. In adjusted, multinomial GEE models, younger age, past month homelessness, more recent enrollment year (2022-2023), regular fentanyl use in the past month, and anxiety disorder were associated with significantly higher odds of membership in the highest utilization group compared to the low/moderate group.
Conclusion: People who use drugs who are younger, past month homelessness, regularly using fentanyl, and having been diagnosed with an anxiety disorder may be more likely to use stimulants frequently, and therefore may be at higher risk of unintentional overdose due to contamination of fentanyl in the illicit drug supply.
