Abstract
Background:
Recent trends show methamphetamine use is increasing in the United States. American Indian and Alaska Native (AI/AN) communities face health disparities compared to the population overall, including some of the highest rates of illegal drug use. Herein, we examined the prevalence of methamphetamine use among AI/ANs and characteristics associated with methamphetamine use among AI/AN people.
Methods:
We examined past-year methamphetamine use from 2015 to 2019 between AI/ANs and the general non-institutionalized U.S. population using the National Survey of Drug Use and Health. Then, we identify potential subgroups of AI/AN people at elevated risk of methamphetamine use across factors including demographic, social determinants, mental health, and co-occurring substance use.
Results:
A total of 214,505 people, aged 18 or older, were surveyed between 2015 and 2019; 3,075 (0.55%) identified as AI/AN. An estimated 26.2 out of every 1000 AI/ANs used methamphetamine compared to 6.8 out of every 1000 in the general U.S. population. Compared to methamphetamine use in the general population, AI/AN methamphetamine use tends to cluster in rural areas and among those with low income. AI/ANs who use methamphetamine were more likely to be male, middle-aged, low income, have severe mental illness, and misuse other substances than AI/AN people who did not use methamphetamine.
Discussion:
AI/ANs experience a disproportionate amount of methamphetamine use in the U.S. To address this disparity, multifaceted, broad prevention, harm reduction, and treatment efforts are needed that leverage cultural strengths to mitigate the consequences of methamphetamine use.
Keywords: Methamphetamine, American Indians, Alaskan Natives, NSDUH, Substance use
1. Introduction
Methamphetamine is a highly addictive, neurotoxic psychostimulant often associated with pervasive health, legal, and environmental consequences (Degenhardt et al., 2017; Halkitis, 2009; Sexton et al., 2006). Methamphetamine use, and co-occurring behaviors such as high-risk sex and violence, can lead to a variety of physical and psychological sequelae such as cardiovascular problems, infectious diseases, and psychosis (Darke et al., 2008; Glasner-Edwards and Mooney, 2014; Kaye et al., 2007; McKetin et al., 2014; Shoptaw and Reback, 2007; Tyner and Fremouw, 2008). Family members of those who use methamphetamine may also experience increased adverse events, including increased child abuse, neglect, and exposure to the foster care system (NSCAW Research Group, 2002; Whiteford et al., 2013). Communities are at risk for experiencing social consequences of methamphetamine use such as increased criminal involvement and systemic violence (Farabee et al., 2002) and increased risk for transmission of infectious diseases like Hepatitis C and HIV (Barr et al., 2006).
Concerningly, methamphetamine is increasingly available, affordable, and more potent forms are prevalent in the United States (U.S.) (U.S. Drug Enforcement Agency, 2018), leading to increased methamphetamine use (Palamar et al., 2020). Current trends of increasing methamphetamine use are associated with upticks in methamphetamine-related consequences, including treatment admissions, injuries, and deaths (Gladden et al., 2019; Jones et al., 2020b; Kariisa et al., 2019). The intersection of person-level factors associated with methamphetamine use, such as other substance use, justice system involvement, and psychiatric conditions, with community-level factors, such as high poverty rates and rurality (Armstrong and Armstrong, 2013; Jones et al., 2020a) leave American Indians and Native Alaskan (AI/AN) communities especially vulnerable to deleterious effects of increased methamphetamine availability. Indeed, AI/AN populations face many health disparities compared to the U.S. population overall, including that AI/ANs have the highest rates of past-year illegal drug use compared to any other racial or ethnic group (Substance Abuse and Mental Health Services Administration (SAMHSA), 2020). Methamphetamine is no exception with an estimated 2.4% of AI/ANs aged 12 and older reporting past-year use in 2018 compared 0.2% to 1.8% of any other assessed racial or ethnic group (SAMHSA 2020). Consistent with the high methamphetamine prevalence, a recent report showed that methamphetamine-involved overdose deaths are the highest among AI/ANs compared to all other assessed racial/ethnic groups (Han et al., 2021). However, particular subsets of AI/AN communities who are at heightened risk of methamphetamine use is currently unknown. The aim of this study was to extend beyond assessing the prevalence of methamphetamine use and overdose, to examine person-level factors associated with AI/AN methamphetamine use to inform future resource allocation for prevention and intervention efforts.
2. Methods
2.1. Procedure
The National Survey of Drug Use and Health (NSDUH) surveys U.S. noninstitutionalized civilians annually, providing nationally representative information about substance use, mental health, and other health-related factors to monitor trends and inform public health needs. The details of the methods of the NSDUH can be found at: https://nsduhweb.rti.org/respweb/about_nsduh.html. This secondary analysis was exempt from review by the University of Michigan Medical School institutional review board.
2.2. Measures
We examined past-year methamphetamine use among adults aged 18 years and older from 2015 to 2019 between AI/ANs and the general U.S. population. Multiple years of data were combined to increase the unweighted number of AI/ANs in the dataset and, thus, enhance the potential stability of the estimates. Documentation of demographic, social factors, mental health, and substance use variables are shown in Supplementary Table 1.
2.3. Analysis
Data were weighted to adjust for nonresponse rates and to provide nationally representative estimates. First, we estimated the prevalence of past-year methamphetamine use for AI/ANs and non-AI/ANs by demographic, social factors, mental health, and substance use characteristics. These variables included sex, age group (18–25 years old, 26 to 34 years old, 35 to 49 years old, and 50 years or older), education (high school diploma or less, more than high school), annual income (less than $20,000, $20,000 to $49,999, $50,000 and up), locality (large metro, small metro, non-metro), health insurance (any coverage, no coverage), mental health status (no mental illness, mental illness, severe mental illness), past-month nicotine dependence, past-month binge drinking, and past-year use of cannabis, heroin, or cocaine, and misuse of prescription opioids, prescription tranquilizers/sedatives, and prescription stimulants. Bivariate statistical comparisons between prevalence of past-year methamphetamine in AI/AN and non-AI/ANs across characteristics were conducted using chi-square tests for 2-level variables and ordinal logistic regression for >2 level variables to allow for omnibus effects (F tests) as well as pairwise comparisons (t tests), as appropriate. Then, we compared characteristics of people who used methamphetamine versus those who did not within AI/ANs. Among AI/ANs, differences in methamphetamine use within demographic, social factors, mental health, and substance use subgroups were calculated using a series of bivariate logistic regressions, using Proc Surveylogistic and Proc SurveyFreq in SAS (SAS Institute Inc., 2013). In the Supplementary Materials we also report a model-adjusted outcomes of the prevalence of methamphetamine between AI/AN and non-AI/AN people across characteristics.
3. Results
Between 2015 and 2019, 214,505 people aged 18 or older were surveyed, of which 3,075 (0.55%) identified as AI/AN. Between 2015 and 2019, an estimated 26.2 (weighted) out of every 1000 AI/ANs used methamphetamine compared to 6.8 (weighted) out of every 1000 in the rest of the U.S. non-institutionalized population. Injection methamphetamine use was similar across AI/AN and non-AI/AN people (20.5% vs. 21.2%, respectively). Compared to methamphetamine use in the general population, AI/AN methamphetamine use tends to cluster in rural areas, with an estimated 61.9% (weighted) of AI/AN methamphetamine use in non-metro localities compared to 20.4% (weighted) among non-AI/ANs (p<0.01). Methamphetamine use between AI/ANs and non-AI/ANs also differed by age (p<0.01) and income (p<0.01), with a higher prevalence of methamphetamine use among middle-aged and lower-income AI/ANs (Table 1). AI/AN people who use methamphetamine report significantly less mental health burden compared to people who use methamphetamine in the general population, with an estimated 66.8% (weighted) of AI/ANs and 41.5% of non-AI/ANs who reported past-year methamphetamine use reporting no mental health symptoms (p=0.01). In general, substance use was lower among AI/ANs who use methamphetamine compared to non-AI/ANs who use methamphetamine, with a significantly lower prevalence of nicotine (AI/AN: 41.3%; non-AI/AN: 56.1%; p=0.03), heroin (AI/AN: 8.8%; non-AI/AN: 17.2%; p=0.04), and cocaine use (AI/AN: 15.2%; non-AI/AN: 31/1%; p<0.01).
Table 1.
Prevalence of demographic, social determinants, mental health, and other substance use among AI/AN and non-AI/AN adults who used methamphetamine in the past year.
| Used methamphetamine | ||||
|---|---|---|---|---|
| AI/AN | Non-AI/AN | |||
| Characteristics | weighted % (95% CI) | weighted % (95% CI) | Prevalence Odds Ratio (95% CI) | p-value |
| Sex | ||||
| Male | 62.0 (51.0, 72.9) | 63.4 (60.7, 66.1) | 0.94 (0.59, 1.51) | 0.79 |
| Female | 38.0 (27.1, 49.0) | 36.6 (33.9, 39.3) | (referent) | |
| Locality | ||||
| Large metro | 16.3 (5.4, 27.3) | 45.1 (40.9, 49.4) | (referent) | <0.01 |
| Small metro | 21.8 (10.5, 33.0) | 34.4 (29.8, 39.1) | 1.75 (0.72, 4.27) | |
| Non-metro | 61.9 (47.3, 76.5) | 20.4 (17.5, 23.4) | 8.39 (3.52, 20.0)b | |
| Age | ||||
| 18 to 25 | 16.9 (8.4, 25.4) | 18.0 (16.1, 20.0) | (referent) | <0.01 |
| 26 to 34 | 27.4 (13.2, 41.6) | 27.2 (24.3, 30.0) | 1.08 (0.42, 2.75) | |
| 35 to 49 | 53.7 (41.9, 65.6) | 32.0 (29.0, 35.1) | 1.79 (1.01, 3.21) | |
| 50 or older | 1.9 (0.0, 4.6) | 22.7 (19.8, 25.6) | 0.09 (0.02, 0.35)b | |
| Education level | ||||
| H.S./GED or less | 64.8 (53.7, 75.9) | 57.9 (54.5, 61.3) | 1.34 (0.80, 2.23) | 0.26 |
| Any college /post H.S. | 35.2 (24.1, 46.3) | 42.1 (38.7, 45.5) | (referent) | |
| Income | ||||
| < $20,000 | 61.4 (50.9, 71.9) | 36.8 (32.8, 40.9) | 1.99 (0.94, 4.21) | <0.01 |
| $20,000 – $49,999 | 15.8 (6.2, 25.4) | 35.9 (32.4, 39.3) | 0.53 (0.17, 1.62) | |
| $50,000 and up | 22.8 (9.0, 36.6) | 27.3 (24.4, 30.1) | (referent) | |
| Health insurance (any) | ||||
| Covered | 88.5 (79.5, 97.5) | 74.9 (71.6, 78.1) | (referent) | 0.03 |
| Not covered | 11.5 (2.5, 20.5) | 25.1 (21.9, 28.4) | 0.38 (0.16, 0.96)b | |
| Mental health status (past year) | ||||
| No mental illness | 66.8 (52.6, 81.0) | 41.5 (38.1, 44.8) | (referent) | 0.01 |
| Mental illness but not severe | 18.0 (7.8, 28.2) | 32.5 (29.8, 35.2) | 0.34 (0.16, 0.73)b | |
| Severe mental illness | 15.2 (4.4, 26.0) | 26.0 (23.0, 29.0) | 0.36 (0.15, 0.90)b | |
| Other substance use | ||||
| Nicotine dependence (past month) | ||||
| Yes | 41.3 (28.2, 54.4) | 56.1 (52.1, 60.0) | 0.55 (0.32, 0.96)b | 0.03 |
| No | 58.7 (45.6, 71.8) | 43.9 (40.0, 47.9) | (referent) | |
| Binge alcohol use (past month) | ||||
| Yes | 50.1 (35.8, 64.4) | 44.1 (40.9, 47.3) | 1.27 (0.72, 2.24) | 0.39 |
| No | 49.9 (35.6, 64.2) | 55.9 (52.7, 59.1) | (referent) | |
| Cannabis (past year) | ||||
| Yes | 66.0 (64.8, 72.1) | 68.5 (64.8, 72.1) | 0.89 (0.26, 3.02) | 0.85 |
| No | 34.0 (27.9, 35.2) | 31.5 (27.9, 35.2) | (referent) | |
| Heroin (past year) | ||||
| Yes | 8.8 (3.2, 14.5) | 17.2 (14.6, 19.7) | 0.47 (0.22, 0.98)b | 0.04 |
| No | 91.2 (85.5, 96.8) | 82.8 (80.3, 85.4) | (referent) | |
| Prescription opioid misuse (past year) | ||||
| Yes | 34.8 (18.9, 50.7) | 39.5 (35.4, 43.5) | 0.82 (0.39, 1.70) | 0.58 |
| No | 65.2 (49.3, 81.1) | 60.5 (56.5, 64.6) | (referent) | |
| Cocaine (past year)a | ||||
| Yes | 15.2 (6.8, 23.6) | 31.1 (28.4, 33.9) | 0.39 (0.20, 0.79)b | <0.01 |
| No | 84.8 (76.4, 93.2) | 68.8 (66.1, 71.6) | (referent) | |
| Prescription tranquilizers or sedatives misuse (past year) | ||||
| Yes | 17.8 (7.9, 27.6) | 28.2 (25.3, 31.1) | 0.55 (0.26, 1.15) | 0.10 |
| No | 82.2 (72.3, 92.0) | 71.8 (68.9, 74.7) | (referent) | |
| Prescription stimulants (past year) | ||||
| Yes | 11.0 (3.1, 18.9) | 20.9 (18.4, 23.4) | 0.47 (0.20, 1.08) | 0.07 |
| No | 89.0 (81.1, 96.8) | 79.1 (76.8, 81.7) | (referent) | |
Abbreviations: AI/AN = American Indian and Alaska Native; High school=H.S.; Graduate equivalency degree=GED;
cocaine includes powder and crack cocaine;
indicates statistically significant bivariate test statistics at p<0.05;
Among AI/ANs, we also compared characteristics of people who used and did not use methamphetamine (Table 2). From 2015 to 2019, AI/AN males, middle-aged persons (35–49 years old), and people making less than $20,000 annually had significantly higher odds of methamphetamine use. More severe mental illness and all examined co-occurring other substance use was associated with a significantly elevated risk of methamphetamine use. Model-adjusted associations in prevalence of methamphetamine use show similar patterns as shown in the above bivariable outcomes (Supplementary Table 2).
Table 2.
Unadjusted disparities in past year methamphetamine use among American Indians/Alaska Natives.
| Methamphetamine use | ||||
|---|---|---|---|---|
| Yes | No | |||
| Characteristics | weighted % (95% CI) | weighted % (95% CI) | Prevalence Odds Ratio (95% CI) | p-value |
| Sex | 0.01 | |||
| Female | 38.0 (27.1, 49.0) | 55.4 (51.1, 59.6) | (referent) | |
| Male | 61.9 (51.0, 72.9) | 44.6 (40.4, 48.9) | 2.02 (1.22, 3.34)b | |
| Age | 0.01 | |||
| 18 to 25 | 16.9 (8.4, 25.4) | 16.7 (14.5, 18.9) | (referent) | |
| 26 to 34 | 27.4 (13.2, 41.6) | 17.2 (15.3, 19.0) | 1.58 (0.62, 3.98) | |
| 35 to 49 | 53.7 (41.9, 65.6) | 23.4 (21.3, 25.4) | 2.27 (1.29, 3.98)b | |
| 50 or older | 1.9 (0.0, 4.6) | 42.8 (38.9, 46.7) | 0.04 (0.01, 0.17)b | |
| Locality | 0.09 | |||
| Large metro | 16.3 (5.4, 27.3) | 23.8 (20.8, 26.7) | (referent) | |
| Small metro | 21.8 (10.5, 33.0) | 30.9 (26.3, 35.6) | 1.03 (0.42, 2.50) | |
| Non-metro | 61.9 (47.3, 76.5) | 45.3 (40.6, 49.9) | 1.99 (0.86, 4.60) | |
| Education | ||||
| College/post H.S. | 35.2 (24.1, 46.3) | 46.4 (43.2, 49.7) | (referent) | 0.08 |
| H.S./GED or less | 64.8 (53.7, 75.9) | 53.6 (50.3, 56.8) | 1.59 (0.93, 2.74) | |
| Income | ||||
| $50,000 and up | 22.8 (9.0, 36.6) | 29.9 (26.6, 33.2) | (referent) | <0.01 |
| $20,000 – $49,999 | 15.8 (6.2, 25.4) | 34.9 (31.5, 38.3) | 0.50 (0.15, 1.81) | |
| < $20,000 | 61.4 (50.9, 71.9) | 35.2 (31.6, 38.8) | 2.28 (1.06, 4.93)b | |
| Health insurance coverage | 0.55 | |||
| Yes | 88.5 (79.5, 97.5) | 90.9 (89.3, 92.5) | (referent) | |
| No | 11.5 (2.5, 20.5) | 9.1 (7.5, 10.7) | 1.30 (0.54, 3.17) | |
| Mental health status (past year) | 0.02 | |||
| No mental illness | 66.8 (52.6, 81.0) | 80.0 (76.8, 83.2) | (referent) | |
| Mental illness but not severe | 18.0 (7.8, 28.2) | 14.3 (11.7, 16.9) | 1.51 (0.74, 3.06) | |
| Severe mental illness | 15.2 (4.4, 26.0) | 5.7 (4.3, 7.0) | 3.22 (1.43, 7.25)b | |
| Other substance use | ||||
| Nicotine dependence (past month) | ||||
| Yes | 41.3 (28.2, 54.4) | 18.2 (15.3, 21.0) | 3.16 (1.87, 5.35)b | <0.01 |
| No | 58.7 (45.6, 71.8) | 81.8 (79.0, 84.6) | (referent) | |
| Binge alcohol use (past month) | ||||
| Yes | 49.9 (35.8, 64.4) | 24.3 (21.1, 27.6) | 3.12 (1.80, 5.40)b | <0.01 |
| No | 50.1 (35.6, 64.2) | 75.7 (72.4, 78.9) | (referent) | |
| Cannabis (past year) | ||||
| Yes | 66.0 (38.8, 93.2) | 20.8 (18.0, 23.6) | 7.39 (2.28, 23.96)b | <0.01 |
| No | 34.0 (6.8, 61.2) | 79.2 (76.4, 82.0) | (referent) | |
| Heroin (past year) | ||||
| Yes | 8.2 (3.2, 14.5) | 0.2 (0.01, 0.28) | 66.2 (25.3, 172.6)b | <0.01 |
| No | 91.2 (85.5, 96.8) | 99.8 (99.7, 99.9) | (referent) | |
| Prescription opioid misuse (past year) | ||||
| Yes | 34.8 (18.9, 50.7) | 5.0 (3.81, 6.17) | 10.2 (4.90, 21.12)b | <0.01 |
| No | 65.2 (49.3, 81.1) | 95.0 (93.8, 96.2) | (referent) | |
| Cocaine (past year) | ||||
| Yes | 15.2 (6.8, 23.6) | 2.3 (1.6, 3.0) | 7.59 (4.03, 14.3)b | <0.01 |
| No | 84.8 (76.4, 93.2) | 97.7 (97.0, 98.4) | (referent) | |
| Prescription tranquilizers or sedatives misuse (past year) | ||||
| Yes | 17.8 (8.0, 27.6) | 1.6 (1.1, 2.2) | 13.0 (5.72, 29.6)b | <0.01 |
| No | 82.2 (72.3, 92.0) | 98.4 (97.8, 98.9) | (referent) | |
| Prescription stimulant misuse (past year) | ||||
| Yes | 11.0 (3.1, 18.9) | 1.2 (0.6, 1.7) | 10.6 (3.83, 29.3)b | <0.01 |
| No | 89.0 (81.1 96.8) | 98.8 (98.3, 99.4) | (referent) | |
Abbreviations: 95% Confidence Interval=95% CI; High school=H.S.; Graduate equivalency degree=GED;
cocaine includes both powder and crack cocaine;
indicates statistically significant pairwise comparison at p<0.05.
4. Discussion
In the U.S., a disproportionate amount of methamphetamine use is among AI/AN people. The prevalence of methamphetamine use is nearly four times higher among AI/ANs than the rest of the American population. To address the disparity in methamphetamine use in AI/AN communities, rapid, multifaceted, and comprehensive methamphetamine prevention, harm reduction, and treatment efforts are needed to mitigate consequences of methamphetamine use and curb risks for potential continued increases in use. To inform where prevention and intervention efforts are most needed, the current report evaluates person-level risk factors for methamphetamine use in AI/AN people compared to the general U.S. population and identifies subsets of AI/ANs with a particularly elevated risk of methamphetamine use.
AI/ANs who use methamphetamine tended to report lower psychiatric load and less co-occurring substance use compared to non-AI/AN people who use methamphetamine. This finding was despite prior work documenting that AI/ANs have the highest prevalence of past-year mental health conditions of any racial or ethnic group examined (Stambaugh et al., 2017). Similar to reports from people who use methamphetamine in rural U.S. communities, AI/AN people may be more likely to use because of pervasive availability and less stigma around methamphetamine use than other illegal drug use (Baker et al., 2020). Whereas non-AI/AN people may be more likely to use in the context of polysubstance use and as a means to cope with mental health distress. Despite the comparatively lower prevalence of co-occurring mental health and substance in AI/AN people who use methamphetamine, mental health and other substance use were still overrepresented among AI/AN people who use methamphetamine compared to those who do not, indicating these factors still increase risk for methamphetamine use among AI/ANs.
Systemic social determinants of health leave AI/AN communities vulnerable to drug epidemics, with these disparities highlighted in current patterns of methamphetamine use among AI/ANs. Identifying people within AI/AN communities at particular risk for methamphetamine use may provide a potential foothold for prevention and treatment responses in these communities. Tailored and effective strategies should prioritize the subsets of AI/AN populations at the most risk of use, namely males, middle-aged people, people with serious mental illness, and people who use other substances, including alcohol and nicotine products. Also notable is prior evidence that the prevalence of methamphetamine use by AI/AN people varies by state, with the American West having the highest rates (e.g., an estimated 3.16% of AI/ANs in Montana and 5.75% in South Dakota), although, in the general U.S. population, methamphetamine use has spread geographically over the past decade (U.S. Drug Enforcement Agency, 2018) with increases in overdose deaths clustered in the West and Midwest (Mattson et al., 2021). If methamphetamine use continues to surge in AI/AN communities, it risks extensive depletion of scarce community resources and treatment services, which could increase community vulnerability to future drug epidemics.
Building on prior methamphetamine-focused initiatives (Walker et al., 2011), the need for increased attention on intervention efforts must be balanced with formative work and partnerships within these communities to better understand reasons for use and non-use within specific socio-cultural contexts and help ensure pragmatic, people-centered strategies, which optimize community engagement and sustainability. Within AI/AN populations, insufficient tribal-sponsored methamphetamine treatment is noted as an ongoing need (SAMHSA, 2008). AI/AN service providers report a need for more treatment resources for AI/ANs in need of treatment, including increased access to inpatient detoxification services and programs designed specifically to treat methamphetamine use (Proctor and McCollum, 2018). One community-driven, culturally-centered treatment, Natural Highs, was developed through the Indian Country Methamphetamine Initiative (Walker et al., 2011). Natural Highs is a tribal adventure therapy that combines experiential activities and traditional interventions to treat methamphetamine use. However, the effectiveness of this treatment and the potential for wide-scale implementation awaits additional study.
Prevention efforts focused on upstream social determinants of health (e.g., employment, education) can be paired with harm reduction strategies. Since one in five people who use methamphetamine use by injection, needle exchange programs for safer use paired with naloxone distribution given increases in the illegal methamphetamine supply being adulterated with opioids are warranted (Park et al., 2021). Others have argued that contingency management, a behavioral intervention that provides incentives for treatment engagement and/or abstinence, should be the first-line treatment for methamphetamine use (Brown and DeFulio, 2020; Roll, 2007). A recent study showed cultural acceptability and efficacy of contingency management in AI/AN communities for treating alcohol use disorders (McDonell et al., 2021); future work to similarly adapt acceptable and feasible versions of contingency management for methamphetamine use in AI/ANs is needed. However, access to contingency management remains uneven, and many AI/AN individuals lack access to this type of care.
In light of barriers to healthcare, including provider shortages and often vast distances to access care, especially among rural AI/AN communities, and the higher prevalence of methamphetamine use among AI/AN people in rural areas, digital or telehealth interventions may have potential for greater reach and accessibility. If telehealth interventions for methamphetamine are acceptable to AI/AN people and effective, the rapid increase in telehealth in the era of the COVID-19 pandemic may be leveraged to increase access to effective methamphetamine treatments in rural areas in particular. Methamphetamine prevention, harm reduction, and treatment efforts within AI/AN communities hold promise to lessen the burden of methamphetamine use and consequences among AI/ANs and the potential to use cultural strengths to fortify these communities against future rises in drug epidemics.
4.1. Limitations
These findings should be considered within the context of study limitations and strengths. The NSDUH is conducted yearly; however, the availability of data is lagged so estimates are always one to two years out-of-date by time of release. In addition to delays between data collection and dissemination, the NSDUH data is limited by the questions included in the survey. Future research in AI/AN people who use methamphetamine may benefit from detailed assessment of cultural norms, beliefs, and values that may impact use and associated consequences, as well as protective factors among AI/AN people and communities that may inform effective prevention and treatment avenues. Furthermore, due to the relatively small sample of AI/AN individuals that use methamphetamine in the NSDUH dataset and that incarcerated or institutionalized individuals are not included, estimates may be subject to instability, and may not achieve the goal of being truly nationally representative. To minimize this limitation, we collapsed the analysis over the five-year period, thus these outcomes are not sensitive to changing trends over this time period, however, the increasing prevalence of methamphetamine use and disproportionate consequences related to methamphetamine use among AI/ANs has been documented previously (Han et al., 2021; Jones et al., 2020a). In consideration of the modest sample of AI/ANs who report methamphetamine use, we elected to focus the outcomes on bivariable associations of methamphetamine use across demographic, social determinants, mental health, and co-occurring substance use characteristics. However, we also present model-adjusted outcomes in Supplementary Table 2. Despite limitations, a strength of this study is the opportunity to look at substance use, mental health, and other health-related characteristics in a national survey of AI/AN adults.
4.2. Conclusions
This study provides initial indicators of differences in methamphetamine use among AI/AN populations compared to the general U.S. population, in addition to identifying disparities among subsets of AI/ANs that use methamphetamine to inform where to target prevention and intervention efforts. By leveraging the cultural strengths of AI/ANs, such as community support, strong connection to family and ancestors, and a rich culture that values land and place, culturally appropriate prevention and treatment interventions may help to reduce this growing disparity.
Supplementary Material
Highlights.
AI/AN communities experience a disproportionate amount of methamphetamine use
Methamphetamine use is nearly 4 times higher in AI/AN compared to non-AI/AN people
AI/AN methamphetamine use tends to cluster among more rural and lower income people
Engaging, accessible, culturally-driven, and sustainable treatment efforts are needed.
Funding:
LNC’s time was funded through NIAAA K23 AA028232. LAL was funded in part by a Career Development Award (CDA 18-008), and MAI was funded in part by a Research Career Scientist Award (RCS 19-333) from VA Health Services Research & Development.
Footnotes
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Disclosures: The authors have no conflicts of interest to disclose.
Conflicts of Interest: The authors of this paper have no conflicts of interest to declare.
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