Abstract
INTRODUCTION:
Methamphetamine (meth) is a stimulant increasing in use and its prevalence has not yet been determined on the Mexico-U.S. border. Few studies highlight gender differences in meth use, trajectory, and initiation by gender. Ciudad Juárez, Mexico, across the border from El Paso, Texas, has an established stimulant using population and lies on drug trafficking route. This study assessed gender differences in drug and meth use patterns among people meth people use meth.
MATERIAL AND METHODS:
This cross-sectional study included 150 people with recent meth use, age 21 years or older, and living in Ciudad Juárez. Measures collected included sociodemographic characteristics, cross-border mobility, drug and meth use characteristics. Statistically (p-value<0.05) and marginally (p-value<0.10) significant gender differences were determined using appropriate bivariate tests.
RESULTS:
The sample included 45 cisgender women, five transgender women, and 100 cisgender men with a mean age of 30.9 years. Men had significantly higher rates of snorting meth by nose in powder or rock forms while trans/women more frequently using meth in pill form. Men had higher rates of crossing the border for work, with meth and to obtain meth. Trans/women reported higher rates of acquiring meth from main sexual partner and initiating meth use in Mexico.
DISCUSSION:
There are gender differences in patterns of meth use and initiation.
CONCLUSIONS:
Sample of people who use meth in general population can be achieved. These findings point to a need for evidence-based meth use reduction treatment programs that are culturally appropriate and tailored for gender.
1. INTRODUCTION
Few studies examine methamphetamine (meth) use patterns, even fewer address populations living along the Mexico-U.S. border or Hispanic populations in the U.S.1 In Mexico, a 2016 national survey indicated 0.9% of the population had ever used amphetamines or stimulants, 0.2% used in the past 12 months, with gender differences between men (1.4%) and women (0.4%).2
There is some evidence of gender differences in meth use in the U.S. Between 2015 and 2018, among adults, lifetime meth use was 59.7 per 1,000 and 6.6 per 1,000 in the past 12 months with gender differences between men (8.7 per 1,000) and women (4.7 per 1,000).3 Reasons for meth use also differ by gender. Among people receiving meth use treatment, primary reasons for use among men included experimentation, increasing sexual pleasure, working longer, and substituting drug of choice and among women, reasons included enjoyment, increasing energy, and staying awake.4 Also, women used meth to lose weight.5,6 Gender differences have been documented for the form and ways meth is used. Mexican and Hispanic men report higher rates of meth use in powder or rock form compared to women who favored ingesting pills and snorting powder.7–10 Along the Mexico-U.S. border, most meth users are male and injecting meth and heroin together is common.11–13
There are ethnic differences in meth use. After non-Hispanic Whites (7.5 per 1,000), Hispanics had the highest rates (6.7 per 1,000) of meth use in the past 12 months.3 Among Hispanics living in El Paso, TX, 8.7% reported illicit drug use and 0.5% reported meth use in the last month14 showing similar rates of meth use among Hispanics in Texas (0.6%).15 A 2012 National Survey on Drug Use and Health (NSDUH) identified Hispanics were 2.82 times likely to have ever used meth compared to African-American adults.16
1.1. Initiation into Methamphetamine Use
Various contextual factors and social influences contribute to the initiation into meth use. Studies on initiation into meth use report mean age at initiation was 19 years old and influenced by their social networks including close friends.4,6,17,18 Other studies demonstrate initiation occurs mostly in locations such as night clubs and friends’ home.6,19 Studies identify smoking as the most common way meth is used during initiation using tin foil or a light bulb.17
Circumstances surrounding initiation into meth use differ by gender. A 2017 study among Latinas in Los Angeles, reasons for initiation included a history of childhood physical, sexual, and emotional abuse.20 Men are introduced to meth by their friends and colleagues.4,18 Other reasons for men included wanting to experiment, replacing a drug, better sex, and to work more while women indicate wanting to get high, have fun, increase their energy, and stay awake.4,21 The mean age at initiation into meth use for men and women were 19.3 and 18.5 years, respectively.4
1.2. Drug Use Trajectory
Meth use trajectory commonly includes polydrug use. In a retrospective study of Californian treatment sites from 1964 to 2003, 95% of primary meth users were using two or more substances in the same month and the most common drug combinations were alcohol and marijuana (15.2%) and meth and alcohol (10.2%).22 In a national study among people entering treatment primarily for opioid use, meth use increased from 2011 (19%) to 2017 (34%).23
Among adults who used meth in the past year, other substances most reported included cannabis (68.7%), prescription opioids (40.4%), and cocaine (30.4%).3 A 2012 NSDUH reported people who ever used meth had increased odds of using cigarettes, marijuana, or alcohol before age 21.16 This study is consistent with an older study recognizing marijuana as the second most commonly used drug by people who use meth.24 Meth and polydrug use trajectory need to be further explored as well as associated health risks, particularly in longitudinal studies.25
A 2010 national substance use survey in Mexico assessing drug use trajectories found that alcohol (49.1%), tobacco (18.4%), and meth were the first drugs of choice for 2.1% of the population.26 Of those initiating drug use with alcohol, 2.8% later used meth while among people who initiated with cocaine, 15% used meth as a second or third drug.26 Meth use trajectory data in Mexico is limited, however, the 2011 report reveals the importance of increasing epidemiological vigilance since meth was identified as the fourth leading drug of impact in 2009 and second drug in 2016 resulting in treatment centers or emergency room admissions, although meth is not the most common drug used.26,27
1.3. Methamphetamine Use Treatment
In 2016, alcohol (39.3%), meth (22.9%), and marijuana (14.3%) were the most common substances that lead to substance use treatment in Mexico.27 Among people who sought treatment in a non-governmental treatment center in Mexico, 54.1% had previously sought treatment for meth use and 86.3% were males.27 In the U.S. during 2015–2018, nearly 53% of adults who reported meth use in the past year were diagnosed with a meth use disorder and less than one third had received treatment.3 Along the Mexico-U.S. border, among those who reported injecting meth, majority reported an urgent need for treatment.12,13 Although there is a higher prevalence of use of other substances, mortality rates among meth users are becoming a priority to health officials due to a 5-fold increase in meth overdose deaths between 2012 and 2018.28
1.4. Gender Roles
Gender differences in meth use on the U.S.-Mexico border may be based on culturally-based gender norms of a predominantly Hispanic community.29 Cultural gender norms in the Hispanic culture include “machismo” (strong, aggressive, or social behavioral roles for men), “marianismo” (nurturing, submissive, supportive, and sexually pure norms for women), and social behaviors that stem from acculturation.9,30,31 Hispanic men, appearing masculine plays a role in substance use, therefore less readily admitting a substance use problem nor seeking assistance through treatment to avoid appearing less “macho”.32–34 Conversely, Hispanic women may reject “marianismo” by engaging in risky behaviors, such as substance use, contrary to their expected gender role.35 Illicit drugs are discouraged among Mexican women due to the caregiving role they play at home.36 Another study on the border indicated that as immigrant generation increased, drug use increased.14 Additionally, among transwomen, a lack of gender affirmation increases likelihood to engage in high-risk behaviors including drug use.37 Among Californian transgender student youth of color, found that transgender students were 2.5 times more likely to use meth or cocaine compared to cisgender students.38 The relationships and dynamics between gender norms and social roles among Hispanics along the U.S.-Mexico border may contribute to gender differences in drug use.
The purpose of this study is to describe gender differences in the factors involved in initiation into methamphetamine (meth) use in a Mexico-U.S. border city.
2. MATERIAL AND METHODS
2.1. Study Design
The Meth Pilot Study is a cross-sectional study. The data was collected at one point in time using mixed methods, using qualitative and quantitative data collection.39
2.2. Study Participants
Participants (N=150) had used meth in the past three months, were living in Cd. Juarez, Mexico, were 21 years old or older, and agreed to participate in the study. To achieve a representative non-probabilistic sample, participants were targeted based on age, gender, types of outreach participants, and cross-border mobility in the last 12 months. Outreach participants included employees from maquilas and truck driving agencies, students, people in party scenes, and drug-using communities including people who engaged in sex work or injected drugs.
2.3. Data Collection
Recruitment and data collection were conducted by Programa Compañeros, A.C. during routine outreach to vulnerable populations for HIV between January 2014 and June 2015. Snowball sampling methods or recruitment by referral was used for recruitment. Two trained staff members administered a five-minute informed consent, conducted the face-to-face audio-recorded interview at the Programa Compañeros’ office or in the field. Participants received the equivalent of $30 USD for their time.
2.4. Measures
The interview included quantitative and qualitative questions. All measures were collected using an adapted questionnaire comprised of several instruments previously developed and used in the region.40 Quantitative measures assessed in this study included measures for sociodemographic characteristics; cross-border mobility; lifetime drug and combination use; initiation into meth use; recent meth use (past 12 months); and lifetime meth use. Measures for cross-border mobility were adapted from the work of Lapeyrouse et al.41 and included nationality, ever visiting El Paso, Texas, currently living in El Paso, years living in El Paso, currently living in Ciudad Juarez, years living in Ciudad Juarez, recent crossing border into the U.S. and El Paso, reasons for going to El Paso, and whether they took meth along a trip to El Paso. Lifetime drug and combination used included alcohol, tobacco, marijuana, heroin, methadone (with and without prescription), crack or cocaine, other opioids (Tramadol, Darvon, Percocet), tranquilizers (Diazepam, Valium, Ativan, or Restoril), barbiturates (including Amytal, Nembutal, or Seconal), inhalants (celestial water, thinner, poppers), hallucinogens (mushrooms, acid, Peyote, PCP), other drugs, and drug combinations (cocaine/crack/heroin, marijuana/cocaine, and other). Qualitative measures assessed initiation into meth use.
2.5. Analysis
Quantitative responses were collected on paper copies of the questionnaire. Data were entered, managed, and analyzed using Statistical Product and Service Solutions (SPSS), Version 25.42 Digital recordings of the qualitative responses from the questionnaire were transcribed verbatim in Spanish by research assistants using Express Scribe Transcription Software43 and Transana Transcription Software.44
2.5.1. Quantifying Qualitative Data
The first step in quantifying qualitative data was to code qualitative data. According to Sandelowsksi,45 qualitative data must be reduced into items, or numeric and coded variables, that should only have one distinct meaning. Pre-determined themes or variables can then be created from these reduced identifiers.46 The pre-determined identifiers for initiation into meth use were organized into individual, social, and structural contextual factors. These identifiers were merged with the existing data set for analysis.47
2.5.2. Statistical Analysis
All measures were summarized using descriptive statistics including median and quartiles or frequencies and percentages. Statistically (p-value<0.05) and marginally (p-value<0.10) significant gender differences were determined using appropriate bivariate tests including Mann-Whitney Test for continuous variables and Pearson Chi-Square, Fisher’s Exact, and Likelihood Ratio tests for categorical variables.
2.6. IRB Approval
The University of Texas at El Paso International Review Board (IRB) approved the study “Social and Contextual Vulnerability on the U.S.-Mexico Border: Vulnerability Issues in Drug Abuse (VIDA)” through August 2010. The Department of Social Services of Chihuahua [Servicios de Salud de Chihuahua] also reviewed and approved the parent study for human subject research.
3. RESULTS
Univariate analyses for all measures are presented by gender and significant gender differences are noted (Tables 1–3). The sample included 100 cisgender men, five transgender women, and 45 cisgender women. Transgender women were combined with women (N=50) and denoted as trans/women.
Table 1:
Gender Differences in Sociodemographic Characteristics and Cross-Border Mobility among People Who Use Meth in a Mexico-U.S. Border City (N=150)
| Trans/Women | Men | ||||
|---|---|---|---|---|---|
| N | Median (Q1, Q3) | N | Median (Q1, Q3) | ||
| Freq (%) | Freq (%) | ||||
| SOCIODEMOGRAPHIC CHARACTERISTICS | |||||
| Age (Years) | 50 | 29 (24, 33) | 100 | 29 (24, 36.8) | |
| Sex at Birth | 50 | 100 | -- | ||
| Male | 5 (10%) | 100 (100%) | |||
| Female | 45 (90%) | 0 (0%) | |||
| Country of birth | 50 | 100 | |||
| Mexico | 42 (84%) | 77 (77%) | |||
| United States | 8 (16%) | 23 (23%) | |||
| Marital Status | 50 | 100 | ** | ||
| Single/Never Married | 27 (54%) | 57 (57%) | |||
| Married/Common Law | 22 (44%) | 31 (31%) | |||
| Divorced/Separated/Widowed | 1 (2%) | 12 (12%) | |||
| Highest level of education completed | 50 | 100 | |||
| Less than High School | 26 (52%) | 56 (56%) | |||
| Completed High School | 4 (8%) | 10 (10%) | |||
| Started Technical Career/University/Other | 11 (22%) | 27 (27%) | |||
| Completed Career/University | 9 (18%) | 7 (7%) | |||
| Country where most of education was completed | 50 | 99 | |||
| Mexico | 40 (80%) | 68 (68.7%) | |||
| United States | 10 (20%) | 31 (31.3%) | |||
| Monthly Income in the last 12 mos. | 50 | 96 | |||
| <$80 USD | 1 (2%) | 1 (1%) | |||
| $80 – $119.92 USD | 2 (4%) | 3 (3.1%) | |||
| $120 – $159.92 USD | 2 (4%) | 5 (5.2%) | |||
| $160 – $199.92 USD | 3 (6%) | 12 (12.5%) | |||
| $200 – $239.92 USD | 3 (6%) | 2 (2.1%) | |||
| $240 – $279.92 USD | 4 (8%) | 6 (6.3%) | |||
| > $280 USD | 35 (70%) | 67 (69.8%) | |||
| Main Source of Income | |||||
| Formal employment with salary/income | 50 | 22 (44%) | 99 | 54 (54.5%) | |
| Informal employment/casual employment | 50 | 14 (28%) | 99 | 39 (39.4%) | |
| Own business | 50 | 9 (18%) | 99 | 11 (11.1%) | |
| Money given by family/partner | 50 | 26 (52%) | 99 | 43 (43.4%) | |
| Money/Loans from friends or acquaintances | 50 | 19 (38%) | 99 | 37 (37.4%) | |
| Charity | 50 | 9 (18%) | 99 | 19 (19.2%) | |
| Selling/Pawning items obtained/owned | 50 | 21 (44.7%) | 99 | 46 (53.5%) | |
| Drug sales | 50 | 12 (24%) | 99 | 33 (33.3%) | |
| Running shooting gallery | 50 | 4 (8%) | 99 | 13 (13.1%) | |
| Commercial sex work | 50 | 18 (36%) | 99 | 10 (10.1%) | ** |
| Pickpocketing/ theft | 50 | 6 (12%) | 99 | 20 (20.2%) | |
| Other | 50 | 10 (20%) | 99 | 21 (21.2%) | |
| CROSS-BORDER MOBILITY | |||||
| Ever visited El Paso, Texas | 50 | 30 (60%) | 100 | 52 (52%) | |
| Currently living in: | 50 | 100 | |||
| Ciudad Juarez | 45 (90%) | 86 (86%) | |||
| El Paso | 4 (8%) | 11 (11%) | |||
| Both | 0 (0%) | 2 (2%) | |||
| Neither | 1 (2%) | 1 (1%) | |||
| Recently crossed border into the U.S. | 50 | 21 (42%) | 100 | 47 (47%) | |
| Recently crossed border to El Paso | 50 | 21 (42%) | 100 | 46 (46%) | |
| Reasons for Going To El Paso | |||||
| Work | 21 | 0 (0%) | 46 | 13 (28.3%) | ** |
| Drugs | 21 | 5 (23.8%) | 46 | 8 (17.4%) | |
| Business | 21 | 1 (4.8%) | 46 | 2 (4.3%) | |
| Education | 21 | 0 (0%) | 46 | 2 (4.3%) | |
| Family | 21 | 9 (42.9%) | 46 | 13 (28.3%) | |
| Partner/relationship | 21 | 0 (0%) | 46 | 4 (8.7%) | |
| Pleasure/entertainment | 21 | 7 (33.3%) | 46 | 14 (30.4%) | |
| Health services/medical attention | 21 | 1 (4.8%) | 46 | 1 (2.2%) | |
| Other | 21 | 1 (4.8%) | 46 | 4 (8.7%) | |
| Took meth along on trip to El Paso | 30 | 3 (10%) | 52 | 15 (28.8%) | ** |
Recent behaviors refer to behaviors in the past 12 months.
Significant ** (p-value<0.05) and marginally * significant (p-value<0.10) bivariate associations were determined by Pearson Chi Square Test, Fisher’s Exact Test, or Likelihood Ratio Test for categorical variables and Mann-Whitney Test for continuous variables.
-- p-value not reported.
Table 3:
Gender Differences in Methamphetamine (meth) Use Initiation among People Who Use Meth in a Mexico-U.S. Border City (N=150)
| Trans/Women | Men | ||||
|---|---|---|---|---|---|
| N | Median (Q1, Q3) | N | Median (Q1, Q3) | ||
| Freq (%) | Freq (%) | ||||
| Age at initiation into meth use (Years) | 50 | 19 (17, 24.3) | 100 | 18 (17, 23) | |
| Reasons for Initiation into Meth Use | |||||
| Curiosity | 50 | 21 (42%) | 100 | 41 (41%) | |
| Emotional or Life Stressors | 50 | 15 (30%) | 100 | 20 (20%) | |
| Peer Pressure | 50 | 10 (20%) | 100 | 22 (22%) | |
| Enjoyment/Pleasure | 50 | 24 (48%) | 100 | 36 (36%) | |
| Environment/Music | 50 | 3 (6%) | 100 | 9 (9%) | |
| Stay Awake/Energy | 50 | 3 (6%) | 100 | 7 (7%) | |
| Sexual Pleasure/Performance | 50 | 4 (8%) | 100 | 12 (12%) | |
| Provided by Sex Partner | 50 | 3 (6%) | 100 | 5 (5%) | |
| Wanted another drug/Drug not available | 50 | 1 (2%) | 100 | 6 (6%) | |
| After attempt to stop use of drugs or entering rehabilitation program | 50 | 3 (6%) | 100 | 4 (4%) | |
| Other | 50 | 11 (22%) | 100 | 24 (24%) | |
| City of initiation into meth use | 20 | 44 | * | ||
| Cd. Juarez, MX | 10 (50%) | 23 (52.3%) | |||
| El Paso, TX | 1 (5%) | 4 (9.1%) | |||
| Another City in Mexico | 7 (35%) | 4 (9.1%) | |||
| Another City in U.S. | 2 (10%) | 13 (29.5%) | |||
| Venue/Event of initiation into meth use | 28 | 61 | |||
| Club | 12 (42.9%) | 20 (32.8%) | |||
| House | 8 (28.6%) | 17 (27.9%) | |||
| No Venue/Musical Event | 6 (21.4%) | 11 (18%) | |||
| Bar | 0 (0%) | 3 (4.9%) | |||
| Jail/Prison | 1 (3.6%) | 1 (1.6%) | |||
| Other | 1 (3.6%) | 9 (14.8%) | |||
| People present during initiation into meth use | 41 | 81 | ** | ||
| Stable Partner | 7 (17.1%) | 3 (3.7%) | |||
| Friend(s) | 26 (63.4%) | 61 (75.3%) | |||
| Family | 2 (4.9%) | 10 (12.3%) | |||
| Sex Work Client | 3 (7.3%) | 0 (0%) | |||
| Sex Partner | 1 (2.4%) | 4 (4.9%) | |||
| Other | 2 (4.9%) | 3 (3.7%) | |||
| Acquisition of meth at initiation | 36 | 76 | |||
| Given to by Friend(s) | 18 (50%) | 43 (56.6%) | |||
| Given to by Family | 4 (11.1%) | 7 (9.2%) | |||
| Given to by Partner | 5 (13.9%) | 4 (5.3%) | |||
| Bought from Dealer | 6 (16.7%) | 15 (19.7%) | |||
| Other | 3 (8.3%) | 7 (9.2%) | |||
| Ways meth was used at initiation | 21 | 59 | |||
| Ingested | 5 (23.8%) | 15 (25.4%) | |||
| Smoked | 11 (52.4%) | 33 (55.9%) | |||
| Inhaled | 0 (0%) | 1 (1.7%) | |||
| Snorted | 4 (19%) | 8 (13.6%) | |||
| Injected | 1 (4.8%) | 2 (3.4%) | |||
| Forms in which meth was used at initiation | 42 | 95 | |||
| Crystal | 21 (50%) | 51 (53.7%) | |||
| Pill | 21 (50%) | 43 (45.3%) | |||
| Rock | 0 (0%) | 1 (1.1%) | |||
| Works used to use meth at initiation | 10 | 28 | |||
| Pipe | 2 (20%) | 4 (14.3%) | |||
| Light Bulb | 5 (50%) | 18 (64.3%) | |||
| Syringe | 0 (0%) | 1 (3.6%) | |||
| Aluminum Foil | 2 (20%) | 3 (10.7%) | |||
| Other | 1 (10%) | 2 (7.1%) |
Recent behaviors refer to behaviors in the past 12 months.
Significant ** (p-value<0.05) and marginally * significant (p-value<0.10) bivariate associations were determined by Pearson Chi Square Test, Fisher’s Exact Test, or Likelihood Ratio Test for categorical variables and Mann-Whitney Test for continuous variables.
-- p-value not reported.
3.1. Descriptive Statistics among Trans/Women
Among trans/women, the median age was 29, 90% were assigned female sex at birth, and 84% were born in Mexico. More than half were single or never married (54%) and completed less than high school education (52%) with 80% completed their education mostly in Mexico. In terms of income in the past 12 months, 70% reported a monthly income above 280 USD and the most common main sources of income were money given by family/partner (52%), selling/pawning items obtained/owned (44.7%), formal employment (44%), and engaging in commercial sex work (36%).
Among trans/women, 60% had ever visited El Paso, TX. In past 12 months, 42% had crossed the border to the U.S. and into El Paso. The most common reasons to cross into El Paso were family (42.9%), pleasure or entertainment (33.3%), and drugs (23.8%). Ten percent took meth with them on their trip to El Paso.
The most common drugs used in lifetime were alcohol (96%), tobacco (94%), marijuana (88%), and crack or cocaine (84%). Almost two-thirds ever used tranquilizers (63.5%) and inhalants (62%). Median time using meth was 8.5 years. The majority had obtained meth in Ciudad Juarez (96%) and two-thirds had ever obtained it in El Paso (66.7%). The most common ways meth was used in their lifetime was ingested (72%) and smoked (70%) mostly in tablet or pill (72%) or powder (48%) form without a work (56%) or using a lightbulb (52%). Overall, 68% reported ever attempting to stop using meth and 23.5% were ever in treatment; one of which was currently in program to stop using meth.
In terms of meth use in the past 12 months, the median number of different people trans/women used meth with was 6 including with friends (97.9%) or sexual partners (31.3%) and most commonly acquired it from a close friend (68%) or acquaintance (30%). The most common ways meth was used in past 12 months were ingested (62%) and smoked (60%) and obtained in a bar, club, or party setting (60%) or in a street, park, or alley (32%). They most commonly used meth in their home or the home of someone they knew (72%) or in a bar, club, or party (54%) and most commonly with a close friend (84%) or with their primary sex partner (42%). In the past 12 months, meth was most commonly combined with cocaine (40%) followed by marijuana (20%) or heroin (20%).
Median age of initiation into meth use was 19 years of age. The most common reasons for initiating meth use were enjoyment or pleasures (48%) or curiosity (42%). Initiation into meth use occurred most commonly in Ciudad Juárez (50%) followed by another city in Mexico (35%). First time use most commonly occurred in a club (42.9%) or a house (28.6%) and around friends (63.4%) or stable partner (17.1%). The first time meth was used, it was most commonly provided by friends (50%) or bought from a dealer (16.7%). The most common ways meth was first used was smoked (52.5%) or ingested (23.8%) in crystal (50%) or pill (50%) form and using a lightbulb (50%).
3.2. Descriptive Statistics among Men
Among men, the median age was 29, 100% were assigned male sex at birth, and 77% were born in Mexico. More than half were single or never married (57%) and completed less than a high school education (56%) which 68.7% completed their education mostly in Mexico.
In terms of income in the past 12 months, 69.8% reported a monthly income above 280 USD and the most common main sources of income were formal employment (54.5%) and selling/pawning items obtained/owned (53.5%). Among men, 52% had ever visited El Paso, TX. In past 12 months, 47% had crossed the border to the U.S. and 46% into El Paso. The most common reasons to crossed into El Paso were pleasure or entertainment (30.4%), work (28.3%), and family (28.3%). Among the men, 28.8% took meth with them on their trip to El Paso. The most common drugs used in the lifetime were alcohol (99%), marijuana (95%), tobacco (94%), and crack or cocaine (94%). Approximately two-thirds ever used tranquilizers (67%) and inhalants (61%).
Median time using meth was 8 years. The majority had obtained meth in Ciudad Juarez (97%) and most had ever obtained it in El Paso (88.5%). The most common way meth was used in the lifetime was smoked (78%) and snorted through nose (71%) mostly in powder (70%) and rock (58%) form using a lightbulb (60%) or pipe (54%). Overall, 65% reported ever attempting to stop using meth and 18.5% were ever in treatment; one of which was currently in program to stop using meth.
In terms of meth use in the past 12 months, the median number of different people men used meth with was 10 including friends (92.8%) or family member (26.8%) and most commonly acquired it from a close friend (62%) or another person (32%). The most common ways meth was used in past 12 months were smoked (65%) or ingested (51%) and obtained in a bar, club, or party setting (53.5%) or in a street, park, or alley (34.3%). They most commonly used meth in their home or the home of someone they knew (76%) or in the bar, club, or party (48%) and most commonly with a close friend (89%) or with their primary sex partner (21%). In the past 12 months, meth was most commonly combined with cocaine (50.5%) followed by marijuana (28%) or heroin (23%).
Median age of initiation into meth use was 18 years of age. The most common reasons for initiating meth use were curiosity (41%) or enjoyment or pleasure (36%). Initiation into meth use occurred most commonly in Ciudad Juárez (52.3%) followed by another city in the U.S. (29.5%). First time use most commonly occurred in a club (32.8%) or a house (27.9%) and around friends (75.3%) or family (12.3%). The first time meth was used, it was most commonly received from friends (56.6%) or bought from a dealer (19.7%). The most common ways meth was first used was smoked (55.9%) or ingested (25.4%) in crystal (53.7%) or pill (45.3%) form and using a lightbulb (64.3%).
3.3. Gender Differences
Statistically and marginally significant gender differences are noted in Tables 1–3. The proportion of those married/common law (44% vs 31%) and engaging in commercial sex work (36% vs 10.1%) was higher for trans/women compared to men. Compared to trans/women, men had significantly higher rates for crossing the border for work (28.3% vs 0%), taking meth to El Paso during one of their trips (28.8% vs 10%), and ever obtaining meth in El Paso or U.S. (88.5% vs 66.7%). In their lifetime, men (94%) used crack or cocaine marginally significantly more than trans/women (84%) used meth use significantly more by snorting it (71% vs 50%) and in powder (70% vs 48%) or rock (58% vs 34%) form compared to trans/women. Trans/women were using meth in tablet/pill (72% vs 55%) more often than men.
Men report recent meth use with more people (median 10 vs 6) and were using with people other than friends, sexual partners, or family members (19.6% vs 8.3%) compared to trans/women. Trans/women reported higher rates of acquiring meth recently from their main sexual partner (16% vs 6%) and another sexual partner (10% vs 2%) compared to men. In recent meth use, men reported significantly higher rates of inhaled (43% vs 24%) or snorted (43% vs 20%) meth use compared to trans/women. Trans/women’s recent use of meth was more often obtaining meth in a hotel (14% vs 4%) and using meth with their primary sex partner (42% vs 21%) compared to men.
After Cd. Juarez, trans/women most often initiated in another city in Mexico (35% vs 9.1%) while men initiated in another city in the U.S. (29.5% vs 10%). Among those who used with others, there were gender differences in persons present during use. After friends, for trans/women, it was most common that their stable partner (17.1% vs 3.7%), for men it was family (12.3% vs. 4.9%) who was present during use.
4. DISCUSSION
Overall, men had significantly higher rates of snorting meth by nose in powder or rock forms while trans/women more frequently reported using meth in pill form. Therefore, gender-specific harm reduction and treatment approaches for meth use are essential.
Although they had similar rates to trans/women for crossing the border to El Paso in the past year, men had higher rates of crossing the border with meth and to obtain meth, overall. Previous analysis of this data among men found that ever obtained meth in El Paso was associated with having sex with men,40 thus pointing to engagement in behaviors in El Paso that perhaps men in this study did not feel open to engage in Cd. Juarez. Also, it was not assessed if taking meth to El Paso involved personal use or drug trafficking.
Trans/women reported higher rates of acquiring meth from primary or other sexual partner (26%) compared to men (8%). This is aligned with study results among Hispanic women who were more than eight times more likely to report having an intimate partner who frequently abused alcohol or drugs during sex.30 Among women in drug treatment facilities for meth use on the border, 41% in San Diego and 37% in Tijuana reported using meth with their sex partners.48 This differs from a U.S. national study which indicates that among those who reported using meth in the past year, 41% bought meth from a friend or relative, 38% got meth from a friend or relative for free, 9% stole from a friend or relative, and 6% bought from a drug dealer or stranger, and 3% got it some other way.49
The most common city of initiation into meth use was Cd. Juárez for both trans/women and men however, the second most common city for trans/women was another city in Mexico, while men reported another city in the U.S. This can reflect gender differences in substance use50,51 or gender differences in migration patterns within Mexico or to the border region.
Lastly, the prevalence of meth use in general population of Cd. Juarez is not available. However, this study indicates that a sample of people who use meth in the general population along the Mexico-U.S. can be achieved. Although most national data from Mexico indicates that meth use with low prevalence but high impact pertains to treatment admissions. This points to a challenge in meth use research where most data available are in context of treatment, not representative of general population of people who use meth. When it comes to drug use trajectory (e.g., lifetime meth use, change in use over time, and polydrug use), patterns are not always documented overtime and hence meth use can be undercounted and certainly understudied.16,24,25
Our findings should be understood within the context of the limitations of our study. First, we point out that our study design was cross-sectional in nature, and therefore, causal relationships could not be determined. Secondly, the instrument failed to include questions about past experiences of abuse and trauma that are known to be factors associated with increase vulnerability to drug use.52–55 This information is essential and relevant to providing appropriate preventative and treatment care recommendations, specifically for meth use among predominantly Hispanic populations or along the Mexico-U.S. border.
Table 2:
Gender Differences in Drug and Methamphetamine (meth) Use among People Who Use Meth in a Mexico-U.S. Border City (N=150)
| Trans/Women | Men | ||||
|---|---|---|---|---|---|
| N | Median (Q1, Q3) | N | Median (Q1, Q3) | ||
| Freq (%) | Freq (%) | ||||
| LIFETIME DRUG AND COMBINATION USE | |||||
| Alcohol | 50 | 48 (96%) | 100 | 99 (99%) | |
| Tobacco | 50 | 47 (94%) | 100 | 94 (94%) | |
| Marijuana | 50 | 44 (88%) | 100 | 95 (95%) | |
| Heroin | 50 | 20 (40%) | 98 | 37 (37.8%) | |
| Methadone without Rx | 50 | 4 (8%) | 98 | 6 (6.1%) | |
| Methadone with Rx | 50 | 13 (26%) | 99 | 18 (18.2%) | |
| Crack or Cocaine | 50 | 42 (84%) | 100 | 94 (94%) | * |
| Other opioids | 50 | 18 (36%) | 100 | 30 (30%) | |
| Tranquilizers | 49 | 32 (65.3%) | 100 | 67 (67%) | |
| Barbiturates | 49 | 1 (2%) | 100 | 2 (2%) | |
| Inhalants | 50 | 31 (62%) | 100 | 61 (61%) | |
| Hallucinogens | 50 | 16 (32%) | 100 | 34 (34%) | |
| Other drugs | 50 | 2 (4%) | 100 | 7 (7%) | |
| Crack or Cocaine and heroin together | 50 | 18 (36%) | 100 | 30 (30%) | |
| Marijuana and cocaine together | 50 | 5 (10%) | 100 | 9 (9%) | |
| Other combinations | 50 | 11 (22%) | 100 | 24 (24%) | |
| LIFETIME METH USE | |||||
| Duration of meth use (Years) | 50 | 8.5 (3, 14) | 100 | 8 (5, 13) | |
| Number of days since last use of meth | 50 | 4.5 (2.8, 14) | 99 | 4 (2, 9) | |
| Ever obtained meth in Cd. Juarez | 50 | 48 (96%) | 99 | 96 (97%) | |
| Ever obtained meth in El Paso or other part of the U.S. | 30 | 20 (66.7%) | 52 | 46 (88.5%) | ** |
| Ways Meth Was Ever Used | |||||
| Smoked | 50 | 35 (70%) | 100 | 78 (78%) | |
| Ingested | 50 | 36 (72%) | 100 | 60 (60%) | |
| Snorted by nose | 50 | 25 (50%) | 100 | 71 (71%) | ** |
| Inhaled through nose | 50 | 26 (52%) | 100 | 59 (59%) | |
| Injected | 50 | 13 (26%) | 100 | 30 (30%) | |
| Other method | 50 | 2 (4%) | 100 | 4 (4%) | |
| Anally | 50 | 1 (2%) | 100 | 4 (4%) | |
| Forms of Meth Ever Used | |||||
| Powder | 50 | 24 (48%) | 100 | 70 (70%) | ** |
| Tablet/pill | 50 | 36 (72%) | 100 | 55 (55%) | ** |
| Rock | 50 | 17 (34%) | 100 | 58 (58%) | ** |
| Smoke | 50 | 16 (32%) | 100 | 29 (29%) | |
| Liquid | 50 | 10 (20%) | 100 | 19 (19%) | |
| Other form | 50 | 6 (12%) | 100 | 17 (17%) | |
| Works Used Ever During Meth Use | |||||
| Lightbulb | 50 | 26 (52%) | 100 | 60 (60%) | |
| Pipe | 50 | 21 (42%) | 100 | 54 (54%) | |
| Straw | 50 | 20 (40%) | 100 | 50 (50%) | |
| Nothing | 50 | 28 (56%) | 100 | 43 (43%) | |
| Foil | 50 | 18 (36%) | 100 | 37 (37%) | |
| Other | 50 | 17 (34%) | 100 | 34 (34%) | |
| Syringe | 50 | 13 (26%) | 100 | 27 (27%) | |
| Money Bill | 50 | 2 (4%) | 100 | 5 (5%) | |
| Stop / Reducing Meth Use | |||||
| Ever attempted to stop using meth | 50 | 34 (68%) | 100 | 65 (65%) | |
| Ever been to treatment for meth use | 34 | 8 (23.5%) | 65 | 12 (18.5%) | |
| Currently enrolled in a program to stop using meth | 8 | 1 (12.5%) | 12 | 1 (8.3%) | |
| RECENT METH USE | |||||
| Number of different people you have used meth with | 50 | 6 (2.8, 10.5) | 100 | 10 (4, 40) | ** |
| Shared Meth With | |||||
| Friends | 48 | 47 (97.9%) | 97 | 90 (92.8%) | |
| Sexual partner(s) | 48 | 15 (31.3%) | 97 | 21 (21.6%) | |
| Stable Partner | 48 | 10 (20.8%) | 97 | 11 (11.3%) | |
| Family member | 48 | 8 (16.7%) | 97 | 26 (26.8%) | |
| Other | 48 | 4 (8.3%) | 97 | 19 (19.6%) | * |
| Meth Was Acquired from Whom | |||||
| Main sexual partner | 50 | 8 (16%) | 100 | 6 (6%) | * |
| Another sexual partner | 50 | 5 (10%) | 100 | 2 (2%) | ** |
| Close friend | 50 | 34 (68%) | 100 | 62 (62%) | |
| Acquaintance | 50 | 15 (30%) | 100 | 25 (25%) | |
| Stranger | 50 | 6 (12%) | 100 | 16 (16%) | |
| Alone | 50 | 3 (6%) | 100 | 2 (2%) | |
| Other | 50 | 12 (24%) | 100 | 32 (32%) | |
| Ways Meth Has Been Used | |||||
| Ingested | 50 | 31 (62%) | 100 | 51 (51%) | |
| Smoked | 50 | 30 (60%) | 100 | 65 (65%) | |
| Inhaled | 50 | 12 (24%) | 100 | 43 (43%) | ** |
| Snorted | 50 | 10 (20%) | 100 | 43 (43%) | ** |
| Injected | 50 | 11 (22%) | 100 | 23 (23%) | |
| Taken anally | 50 | 0 (0%) | 100 | 3 (3%) | |
| Place Where Meth Was Obtained | |||||
| Bar, Club, Party | 50 | 30 (60%) | 99 | 53 (53.5%) | |
| Street/Park/Alley | 50 | 16 (32%) | 99 | 34 (34.3%) | |
| Own/partner’s/friend’s house or apartment | 50 | 12 (24%) | 99 | 28 (28.3%) | |
| Seller’s house or apartment | 50 | 15 (30%) | 99 | 20 (20.2%) | |
| Telephone/Dealers | 50 | 7 (14%) | 100 | 15 (15%) | |
| Other | 50 | 5 (10%) | 99 | 16 (16.2%) | |
| Hotel | 50 | 7 (14%) | 99 | 4 (4%) | ** |
| Shooting gallery | 50 | 1 (2%) | 99 | 7 (7.1%) | |
| Store/Market | 50 | 3 (6%) | 100 | 5 (5%) | |
| Mall | 50 | 3 (6%) | 100 | 4 (4%) | |
| Workplace | 50 | 0 (0%) | 99 | 2 (2%) | |
| Prison, Jail | 50 | 0 (0%) | 99 | 1 (1%) | |
| Car | 50 | 0 (0%) | 99 | 1 (1%) | |
| Public Restroom | 50 | 0 (0%) | 99 | 0 (0%) | -- |
| Place Where Meth Was Used | |||||
| Own/partner’s/friend’s/cousin’s house/apartment | 50 | 36 (72%) | 100 | 76 (76%) | |
| Bar, Club, Party | 50 | 27 (54%) | 100 | 48 (48%) | |
| Hotel | 50 | 10 (20%) | 100 | 12 (12%) | |
| Street, Park, Alley | 50 | 5 (10%) | 100 | 16 (16%) | |
| Other | 50 | 2 (4%) | 100 | 7 (7%) | |
| Shooting gallery | 50 | 3 (6%) | 100 | 5 (5%) | |
| Seller’s house or apartment | 50 | 4 (8%) | 100 | 3 (3%) | |
| Car | 50 | 3 (6%) | 100 | 3 (3%) | |
| Workplace | 50 | 1 (2%) | 100 | 3 (3%) | |
| Public Restroom | 50 | 1 (2%) | 100 | 2 (2%) | |
| Prison, Jail | 50 | 1 (2%) | 100 | 0 (0%) | |
| People Whom Meth Was Used | |||||
| Close Friend | 50 | 42 (84%) | 100 | 89 (89%) | |
| Primary sex partner | 50 | 21 (42%) | 100 | 21 (21%) | ** |
| Other sex partner or client | 50 | 5 (10%) | 100 | 11 (11%) | |
| Alone | 50 | 8 (16%) | 100 | 8 (8%) | |
| Family | 50 | 5 (10%) | 100 | 11 (11%) | |
| Acquaintance | 50 | 3 (6%) | 100 | 9 (9%) | |
| Stranger | 50 | 1 (2%) | 100 | 2 (2%) | |
| Other | 50 | 1 (2%) | 100 | 2 (2%) | |
| Meth and Drug Combination Use | |||||
| Meth and cocaine | 50 | 20 (40%) | 99 | 50 (50.5%) | |
| Meth and marijuana | 50 | 10 (20%) | 100 | 28 (28%) | |
| Meth and heroin | 50 | 10 (20%) | 100 | 23 (23%) | |
| Meth and alcohol | 50 | 8 (16%) | 100 | 11 (11%) | |
| Meth and hallucinogens | 50 | 4 (8%) | 100 | 5 (5%) | |
| Other combination with Meth | 50 | 4 (8%) | 100 | 4 (4%) |
Recent behaviors refer to behaviors in the past 12 months.
Significant ** (p-value<0.05) and marginally * significant (p-value<0.10) bivariate associations were determined by Pearson Chi Square Test, Fisher’s Exact Test, or Likelihood Ratio Test for categorical variables and Mann-Whitney Test for continuous variables.
-- p-value not reported.
5. ACKNOWLEDGEMENTS
This work was funded by UTEP Vulnerability Issues in Drug Abuse (VIDA) Project (NIH-NIDA 1R24DA029989-01) funded by National Institute on Drug Abuse (NIDA) and by the UTEP Hispanic Health Disparities Research Center (HHDRC) (Bethesda, Maryland) awarded to PI Edward Castaneda, Ph.D. Project possible through the collaboration and trust with Alliance of Border Collaborative (ABC) in El Paso, TX, and Programa Compañeros, A.C. in Cd. Juarez, Mexico, and the participants who share their experiences. Faculty mentoring support came from the Interdisciplinary Research Training Institute (IRTI) Program (NIH-NIDA R25 DA026401) at the University of Southern California, School of Social Work. The authors also thank the VIDA mentees and trainees.
Footnotes
DECLARATION OF INTEREST
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
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