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. Author manuscript; available in PMC: 2022 Jun 1.
Published in final edited form as: Addict Behav. 2021 Jan 19;117:106831. doi: 10.1016/j.addbeh.2021.106831

Event-level patterns of methamphetamine and poly-drug use among millennial sexual minority men: the P18 cohort study

Richard J Martino 1, Stephanie Shiau 2, Kristen D Krause 1,3, Perry N Halkitis 1,2,4
PMCID: PMC8855463  NIHMSID: NIHMS1771683  PMID: 33588290

Abstract

Introduction:

Knowledge on methamphetamine use among a new generation of sexual minority men (SMM) is limited. This study describes the event-level patterns of methamphetamine use and characteristics of methamphetamine users across time among Millennial SMM emerging into adulthood.

Methods:

A prospective cohort study was conducted in two waves: 2009–2014 (Wave I) and 2014–2019 (Wave II) in the New York City metropolitan area. A total of 600 Millennial SMM ages 18–19 years were recruited for Wave I. A total of 665 SMM ages 22–23 years were recruited for Wave II, of which 41.2% (n=274) were retained from Wave I. The Timeline Followback assessment was conducted every six months to record event-level drug use in the 30 days prior to the visit.

Results:

A total of 5.4% of participants of between the ages of 18–27 reported methamphetamine use throughout the study period. The average number of days of methamphetamine use was significantly higher among racial/ethnic minority men in Wave II (F=4.34, p=0.0029). We found methamphetamine use occurred more often on weekend days and same-day use of methamphetamine occurred most often with cannabis and gamma-hydroxybutyrate. Usage of methamphetamine was significantly greater among SMM in Wave II who by design were older than Wave I.

Conclusion:

We have identified differences in methamphetamine use by race/ethnicity. Weekend use and poly-drug use were common among methamphetamine-using SMM. Data indicate differential use in the population and that attempts to address this addictive behavior must be linked to other drug use and socialization among young SMM.

Keywords: methamphetamine, SMM, sexual minority, race/ethnic minority, calendar-based methods, poly-drug use

1. Introduction

Methamphetamine, also referred to as crystal meth, Tina, ice, glass, or speed, is a highly potent and addictive stimulant that affects the central nervous system and can significantly impact physical, mental, social, and sexual health (Darke, Duflou, et al., 2017; Darke, Kaye, et al., 2017; Prakash et al., 2017; Strathdee & Stockman, 2010; Uhlmann et al., 2014). In 2018, approximately 1.9 million people 12 years of age and older used methamphetamine in the past year, corresponding to 0.7% of the population in the United States (U.S) (Substance Abuse and Mental Health Services Administration, 2019a). Methamphetamine-related deaths and hospitalizations have risen drastically from 2008–2015, amidst an ongoing opioid epidemic (Jones et al., 2020; U.S. Department of Justice Drug Enforcement Administration, 2017; Winkelman et al., 2018).

For sexual and gender minority individuals in the U.S, there has been a decrease in methamphetamine use for ages 18–25 (2.0% to 1.3%) but an increase for ages 26 or older (1.5% to 2.9%) from 2017 to 2018 (Substance Abuse and Mental Health Services Administration, 2019b). These data, while useful, do not provide information on the local contexts surrounding methamphetamine use. Changes in the geographic availability of methamphetamine have disproportionately affected poor and marginalized populations, including rural and urban and minority communities (Dombrowski et al., 2016).

Now with a resurgence of methamphetamine use among sexual minority men (SMM), little data on methamphetamine use patterns are available for a new generation of young SMM, namely Millennials, defined as the generation born between 1981 and 1996 (Dimock, 2019; Pew Research Center, 2019). Millennial SMM may have emerged into adulthood after the efforts to address methamphetamine use in the population had subsided (Fierstein et al., 2006; Halkitis et al., 2006; Halkitis et al., 2001; Jack et al., 2006). This period of emerging adulthood, defined as the period between adolescence and adulthood from ages 18 to 25 or 18 to 29 (Arnett, 2000; Arnett et al., 2014), has been shown to be a time of exploration and experimentation of sexual behaviors and drug use (Cook et al., 2018; Halkitis et al., 2015; P. N. Halkitis et al., 2014; Kapadia et al., 2015; Tucker et al., 2005).

Currently, what we know about methamphetamine use is drawn either from locally based studies (Dombrowski et al., 2012; Hoenigl et al., 2016; Mackesy-Amiti et al., 2008; Nerlander et al., 2018; Wohl et al., 2008) and the National HIV Behavioral Surveillance (Centers for Disease Control and Prevention, 2019b). Thus, there is a limitation in the epidemiological data of methamphetamine use by sexual identity and specifically in a new generation of SMM coming of age in a local context. Previously, methamphetamine use among sexual and gender minority groups has been associated with demographic characteristics, such as being older and living with HIV (Halkitis et al., 2008; Melendez-Torres et al., 2016; Nerlander et al., 2018). While methamphetamine research has focused on White SMM, more recent research had found that racial and ethnic differences of methamphetamine use vary by population (Halkitis et al., 2008; Irwin & Morgenstern, 2005; Wohl et al., 2008). The aim of this study was to provide a detailed report of event-level methamphetamine use and to describe the differences of methamphetamine use by key demographics for Millennial SMM drawn from a robust cohort study of SMM in the New York City area. We hypothesize that there are differences in event-level methamphetamine use among sociodemographic characteristics, such as race/ethnicity and sexual identity.

2. Materials and methods

2.1. Study Population

This analysis utilized data collected from Wave I and Wave II of the P18 Cohort Study, a longitudinal investigation of young SMM living in the New York City metropolitan area conducted from 2009–2019 in two waves, each with 7 visits at six-month intervals. The first wave of the study (Wave I) was funded in March 2009; participant recruitment occurred in New York City via active and passive modalities between June 2009 and May 2011. Detailed recruitment and enrollment procedures were previously published (Halkitis et al., 2018; Halkitis, Kapadia, et al., 2013; Halkitis, Moeller, et al., 2013). Briefly, participants were recruited via venue- (e.g. community events, service agencies, public spaces, bars/clubs) and internet-based (e.g. social networking sites) modalities. The eligibility criteria were: (1) 18 or 19 years of age for Wave I and 22 or 23 years of age for Wave II; (2) biologically male; (3) resident of the NYC metro area; (4) sexually active with a man in the 6 months preceding screening (not including cyber or phone sex); and (5) self-reported HIV negative serostatus at the time of screening for eligibility. HIV antibody testing was conducted at baseline, irrespective of self-reported status, and at every subsequent visit for HIV negative participants.

The sample size for Wave I consisted of 600 participants in the New York metropolitan area. All participants in Wave I were eligible for Wave II, including those who tested HIV positive. A total of 598 participants from Wave I and 665 participants from Wave II contributed measurements to this analysis. As previously reported (D’Avanzo et al., 2016; Halkitis et al., 2015), two participants from Wave I were excluded due to missing data at baseline. Of the 665 participants in Wave II, 274 (41.2%) participants previously participated in Wave I and 391 (58.8%) were new participants. All P18 Cohort Study activities were approved by the Institutional Review Board at New York University.

2.2. Measurements

At each study visit, participants completed an audio-computer assisted self-interview (ACASI) to provide information on sociodemographic characteristics, individual psychosocial factors, and their health behaviors.

2.2.1. Demographic Characteristics

Race/ethnicity was ascertained through the use of a single survey item and categorized as Hispanic/Latino, Black Non-Hispanic, Asian Non-Hispanic, Multiracial/Other Non-Hispanic, and White Non-Hispanic. Participants self-reported perceived familial socioeconomic status (SES), which was used as a proxy for household-level income and categorized as lower, middle and upper class in Wave I. Sexual identity was defined using the Kinsey scale with participants identifying as “predominately” or “exclusively” homosexual coded as gay identified.

2.2.2. Timeline Followback drug use data

Data on recent alcohol and other drug use and sexual behavior were obtained at each visit using the Timeline Followback (TLFB) calendar-based method (Sobell et al., 1996). The TLFB is a semi-structured, interviewer-administered assessment designed to collect detailed information on activities for the 30 days preceding each study visit.

Participants were asked to report the use of any of the following substances on each day of the 30-day period prior to assessment: alcohol, cocaine, crack, ecstasy, GHB, opiates (i.e., heroin, opium, morphine), ketamine, cannabis, methamphetamine, inhalant nitrates (poppers), inhalants (other than poppers), hallucinogens, erectile enhancers (i.e., Cialis, Levitra, Viagra), and non-prescribed pharmaceuticals such as pain killers, anxiolytics, sleeping pills, and cough medicine. It should be noted that the Wave I baseline visit did not collect data on alcohol to intoxication, inhalants, and hallucinogens, while sleeping pills, anxiolytics, opiates except heroin, and pain killers were not recorded during the baseline and 6-month visits. Cough medicine was not recorded for the baseline, 6-month, and 12-month visits.

2.3. Statistical Methods

First, descriptive characteristics were used to describe the study population and the subgroup of participants who reported lifetime methamphetamine use, defined as ever reporting methamphetamine use from the TLFB, by baseline characteristics for each wave. Age was expressed as means and standard deviations while the other demographic characteristics were reported as frequencies along with percentages and 95% confidence intervals (95% CI). Pearson’s chi-square test of equal proportions and repeated measures ANOVA were performed to test significant differences of methamphetamine use among participants who reported lifetime methamphetamine use by demographic characteristics and days of the week. Age of first reported methamphetamine use was recorded by identifying the age of the participant at the first assessment they reported methamphetamine use in the TLFB.

By capitalizing on the event-level drug use data, we categorized days where methamphetamine and other drugs were used as same-day use. We also reported the average number of methamphetamine use days by each day of the week recorded in the TLFB. We reported cocaine use to examine differences in rates of stimulant drug use within the population. An alpha level of 0.05 was used as the cutoff for significance. All analyses were conducted with SAS 9.4 (Cary, NC) (SAS Institute Inc, 2016).

3. Results

3.1. Overall P18 Cohort Study demographic data

Demographic characteristics at the baseline visit for each wave for all participants and for participants who reported any lifetime methamphetamine use are shown in Table 1. For the 598 participants in Wave I, 38.1% were Hispanic/Latino, 29.1% were White non-Hispanic (NH), 14.9% were Black NH, 9.4% were multiracial NH, 4.9% were Asian NH, and 3.7% were Native American/Other NH. Most of the total participants in Wave I identified as gay (70.7%), U.S born (89.0%), and HIV negative (94%). For the total sample in Wave II, 31.9% were Hispanic/Latino, 25.6% were Black NH, 25.3% were White NH, 7.4% were Asian NH, 6.5% were multiracial NH, and 3.5% were Native American/Other NH. Similar to Wave I, a majority of participants in Wave II identified as gay (82.3%), U.S born (84.2%), and HIV negative (89.6%).

Table 1.

Demographic characteristics at the baseline visit for each Wave for all participants and for participants who reported any lifetime methamphetamine use.

Wave I Wave II
Wave I Total (n = 598)1 Lifetime methamphetamine Use (n = 13) Wave II Total (n = 665) Lifetime methamphetamine Use (n = 47)
n %2 95% CI n %2 95% CI n %2 95% CI n %2 95% CI
Age (Mean ± Standard Deviation) 18.23 ± 0.43 18.15 ± 0.38 22.49 ± 0.61 22.34 ± 0.73
Race/Ethnicity
 Hispanic/Latino 228 38.1% (34.2%, 42.0%) 8 61.5% (35.1%, 88.0%) 212 31.9% (28.3%, 35.4%) 19 40.4% (26.4%, 54.5%)
 Black NH 89 14.9% (12.0%, 17.7%) 4 30.8% (05.7%, 55.9%) 170 25.6% (22.2%, 28.9%) 10 21.3% (09.6%, 33.0%)
 White NH 174 29.1% (25.5%, 32.7%) 1 7.7% (00.0%, 22.2%) 168 25.3% (22.0%, 28.6%) 9 19.2% (07.9%, 30.4%)
 Asian NH 29 4.9% (03.1%, 06.6%) 0 0.0% (00.0%, 00.0%) 49 7.4% (05.4%, 09.4%) 5 10.6% (01.8%, 19.5%)
 Multiracial NH 56 9.4% (07.0%, 11.7%) 0 0.0% (00.0%, 00.0%) 43 6.5% (04.6%, 08.3%) 2 4.3% (00.0%, 10.0%)
 Native American/Other NH 22 3.7% (02.2%, 05.2%) 0 0.0% (00.0%, 00.0%) 23 3.5% (02.1%, 04.8%) 2 4.3% (00.0%, 10.0%)
U.S Born
 No 66 11.0% (08.5%, 13.5%) 2 15.4% (00.0%, 35.0%) 104 15.6% (12.9%, 18.4%) 6 12.8% (03.2%, 22.3%)
 Yes 532 89.0% (86.5%, 91.5%) 11 84.6% (65.0%, 100.0%) 560 84.2% (81.4%, 87.0%) 41 87.2% (77.7%, 96.8%)
Missing 0 0.0% (00.0%, 00.0%) 0 0.0% (00.0%, 00.0%) 1 0.2% (00.0%, 00.4%) 0 0.0% (00.0%, 00.0%)
Gay Identity
 No 175 29.3% (25.6%, 32.9%) 3 23.1% (00.2%, 46.0%) 118 17.7% (14.8%, 20.6%) 7 14.9% (04.7%, 25.1%)
 Yes 423 70.7% (67.1%, 74.4%) 10 76.9% (54.0%, 99.8%) 547 82.3% (79.4%, 85.2%) 40 85.1% (74.9%, 95.3%)
Perceived Familial SES3
 Lower 200 33.4% (29.7%, 37.2%) 10 76.9% (54.0%, 99.8%) NR NR NR NR NR NR
 Middle 221 37.0% (33.1%, 40.8%) 3 23.1% (00.2%, 46.0%) NR NR NR NR NR NR
 Upper 176 29.4% (25.8%, 33.1%) 0 0.0% (00.0%, 00.0%) NR NR NR NR NR NR
 Missing 1 0.2% (00.0%, 00.5%) 0 0.0% (00.0%, 00.0%) NR NR NR NR NR NR
School Enrollment
 No 85 14.2% (11.4%, 17.0%) 2 15.4% (00.0%, 35.0%) 443 66.6% (63.0%, 70.2%) 29 61.7% (47.8%, 75.6%)
 Yes 512 85.6% (82.8%, 88.4%) 11 84.6% (65.0%, 100.0%) 222 33.4% (29.8%, 37.0%) 18 38.3% (24.4%, 52.2%)
 Missing 1 0.2% (00.0%, 00.5%) 0 0.0% (00.0%, 00.0%) 0 0.0% (00.0%, 00.0%) 0 0.0% (00.0%, 00.0%)
Highest level of education completed
 High school diploma or less 591 98.8% (98.0%, 99.7%) 12 92.3% (77.8%, 100.0%) 318 47.8% (44.0%, 51.6%) 32 68.1% (54.8%, 81.4%)
 Associate’s degree 0 0.0% (00.0%, 00.0%) 0 0.0% (00.0%, 00.0%) 78 11.7% (09.3%, 14.2%) 6 12.8% (03.2%, 22.3%)
 Bachelor’s degree 0 0.0% (00.0%, 00.0%) 0 0.0% (00.0%, 00.0%) 260 39.1% (35.4%, 42.8%) 8 17.0% (06.3%, 27.8%)
 Graduate degree 1 0.2% (00.0%, 00.5%) 0 0.0% (00.0%, 00.0%) 8 1.2% (00.4%, 02.0%) 1 2.1% (00.0%, 06.3%)
 Missing 6 1.0% (00.2%, 01.8%) 1 7.7% (00.0%, 22.2%) 1 0.2% (00.0%, 00.4%) 0 0.0% (00.0%, 00.0%)
HIV Status
 HIV− 542 94.0% (88.3%, 93.0%) 12 92.3% (77.8%, 100.0%) 596 89.6% (87.3%, 91.9%) 37 78.7% (67.0%, 90.4%)
 HIV+ 36 6.0% (4.1%, 07.9%) 1 7.7% (00.0%, 22.2%) 69 10.4% (8.1%, 12.7%) 10 21.3% (9.6%, 33.0%)
Total 598 13 665 47
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1

The baseline study sample is 598 due to missing data for two participants.

2

Column percent.

3

Perceived familial SES was not recorded in Wave II.

3.2. Study sample with reported methamphetamine use

A total of 53 unique participants reported lifetime methamphetamine use across the two waves. Of those who reported lifetime methamphetamine use, 13 participants reported lifetime methamphetamine use in Wave I and 47 participants reported lifetime methamphetamine use in Wave II. Given that there were 990 unique individuals across both waves, this translates to a prevalence of 5.4% of Millennial SMM reporting usage of methamphetamine prior to the age of 28. The incidence rate for methamphetamine use throughout the entire cohort study was 1.6 per 100 person-years. The cumulative incidence was 3.0% for Wave I and 9.6% for Wave II suggesting a pattern of greater onset as the cohort aged.

In Wave I, 13 (2.2%, 95% CI = 1.0%–3.3%) participants reported lifetime methamphetamine use while a significantly greater percentage reported lifetime methamphetamine use in Wave II (n=47; 7.1%, 95%CI = 5.1%–9.0%) (χ2 = 16.66, p < 0.0001) (Table 1). For participants that reported lifetime methamphetamine use in Wave II (n=47), 44 (93.62%) participants reported current methamphetamine use in the Wave II TLFBs while 3 (6.38%) participants reported previous methamphetamine use from the Wave I TLFBs and did not report methamphetamine use during Wave II. Participants that reported current methamphetamine use in Wave II included 27 (61.36%) new participants unique to Wave II, 13 (29.55%) participants from Wave I who did not report use in Wave I, and the 4 (9.09%) participants from Wave I who continued using methamphetamine in Wave II.

3.3. Demographic characteristics of participants who reported methamphetamine use

3.3.1. Differences by race/ethnicity.

In Wave I, 61.5%, 30.8%, and 7.7% of participants who reported methamphetamine use were Hispanic/Latino, Black NH, and White NH, respectively (Table 1). While in Wave II, 31.9%, 25.6%, 25.3%, 7.4%, 6.5% and 3.5% of participants who reported methamphetamine use were Hispanic/Latino, Black NH, White NH, Asian NH, multiracial NH, and Native American/Other NH, respectively. While the average number of days of methamphetamine use reported in Wave I were not statistically significant, use was highest among Hispanic/Latino (Mean=7.63 ± 14.50) and Black NH (Mean=7.75 ± 11.00), and White NH (Mean=1.00 ± 0.00) participants (F=0.19, p=0.8282).

In Wave II, the mean days of methamphetamine use in were significantly different (F = 4.34, p = 0.0029) by race/ethnicity with the highest average of methamphetamine days among Native American/Other NH participants (Mean=44.00 ± 8.49) followed by Hispanic/Latino (Mean=12.82 ± 18.54), Black NH (Mean=8.11 ± 7.66), multiracial NH (Mean=7.50 ± 0.71), White NH (Mean=5.33 ± 5.10), and Asian NH (Mean=1.60 ± 1.34) participants.

3.3.2. Differences by U.S birth status and gay identity

Of those who used methamphetamine in their lifetime, a higher percentage were U.S born with 84.62% (χ2 = 6.23, p = 0.013) in Wave I and 87.23% (χ2 = 26.06, p < 0.0001) in Wave II compared to foreign-born participants. Participants who identified as gay made up a larger percentage of those who used methamphetamine compared to non-gay identified participants in Wave II (Wave I: χ2 = 3.77, p = 0.0522; Wave II: χ2 = 23.17, p < 0.0001).

3.4. Methamphetamine use by age and number of events.

The age at which methamphetamine use was first reported in the TLFB varied (Table 2). A majority of participants in Wave I reported methamphetamine use at one visit (76.9%) with 53.9% of participants reporting one day of methamphetamine use. In Wave II, 43.2% of participants reported methamphetamine use at one visit with 22.7% of participants reporting one day of methamphetamine use.

Table 2.

Frequency of demographics and daily methamphetamine use among 53 participants who reported lifetime methamphetamine use.

Wave 1 (n=13) Wave 2 (n=47)
Number of Participants Percentage of Participants 95% CI Number of Participants Percentage of Participants 95% CI
Age at first reported methamphetamine use1
18 3 23.1% (00.2%, 46.0%) 22 13 32.5% (18.0%, 47.0%)
19 5 38.5% (12.0%, 64.9%) 23 10 25.0% (11.6%, 38.4%)
20 1 7.7% (00.0%, 22.2%) 24 8 20.0% (7.6%, 32.4%)
21 4 30.8% (5.7%, 55.9%) 25 9 22.5% (9.6%, 35.4%)
Number of visits of reported methamphetamine use
1 Visit 10 76.9% (54.0%, 99.8%) 1 Visit 19 43.2% (26.4%, 54.5%)
2–3 Visits 2 15.4% (00.0%, 35.0%) 2–3 Visits 17 38.6% (22.4%, 49.9%)
4–6 Visits 1 7.7% (00.0%, 22.2%) 4–6 Visits 8 18.2% (6.3%, 27.8%)
Number of days of reported methamphetamine Use
1 day 7 53.9% (26.7%, 80.9%) 1 day 10 22.7% (9.6%, 33.0%)
2–5 days 3 23.1% (00.2%, 46.0%) 2–5 days 17 38.6% (22.4%, 49.9%)
6–10 days 1 7.7% (00.0%, 22.2%) 6–10 days 6 13.6% (3.2%, 22.3%)
11–20 days 0 0.0% (00.0%, 00.0%) 11–20 days 5 11.4% (1.8%, 19.5%)
21–30 days 1 7.7% (00.0%, 22.2%) 21–30 days 2 4.6% (00.0%, 10.0%)
31+ days 1 7.7% (00.0%, 22.2%) 31+ days 4 9.1% (00.5%, 16.5%)
HIV Status
HIV− 12 92.3% (77.8%, 100.0%) HIV− 37 78.7% (67.0%, 90.4%)
HIV+ 1 7.7% (00.0%, 22.2%) HIV+ 7 14.9% (4.7%, 25.1%)
HIV+ in Wave I 2 3 6.4% (00.0%, 13.4%)
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1

Sample size for Age for Wave II is 40 participants due to 7 participants first using methamphetamine in Wave I.

2

Participants tested HIV positive in Wave I who did not report methamphetamine use until Wave II.

3.5. Methamphetamine use by day of the week

From both waves, there were 543 total days of methamphetamine use reported from the TLFB and the average number of methamphetamine use days was 10.25 days (± 14.71) for the 53 participants. By day of the week, methamphetamine use occurred more frequently on weekends. As shown in Figure 1, the average number of days of methamphetamine use for the 53 participants were highest on Saturday (Mean=1.70 ± 2.87), Sunday (Mean=1.64 ± 2.58), and Friday (Mean=1.58 ± 2.86) followed by Thursday (Mean=1.34 ± 1.97), Tuesday (Mean=1.34, ± 1.95), Monday (Mean=1.36 ± 2.03) and Wednesday (Mean=1.28 ± 2.13). Average number of methamphetamine days were not statistically significantly different between days of the week (F = 0.37, p = 0.8993) or between weekdays (Monday-Thursday) and weekend days (Friday-Sunday) (F = 1.60, p = 0.2121).

Figure 1.

Figure 1.

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Average number of days of methamphetamine use for each day of the week reported from the Timeline Followback calendar-based data.

3.6. Same-day methamphetamine poly-drug use data.

We analyzed same-day methamphetamine poly-drug use, defined as the use of methamphetamine and another drug on the same day, to further describe drug use patterns of methamphetamine use within this Millennial SMM group (Table 3). The highest percentages of same-day methamphetamine poly-drug days were cannabis (37.75%, 95% CI = 33.7%–41.8%), GHB (28.36%, 95% CI = 24.6%–32.2%), and poppers (alkyl nitrites) (17.68%, 95% CI = 14.5%–20.9%) compared to days of methamphetamine use without that drug.

Table 3.

Frequency of daily simultaneous use of methamphetamine and a second drug for participants who reported methamphetamine use in the TLFB (N = 53)

Days of use of methamphetamine and Another Drug Days of use of methamphetamine without the Other Drug
Number of Days % 95% CI Number of Days % 95% CI Total2
Cannabis 205 37.75% (33.7%, 41.8%) 338 62.25% (58.2%, 66.3%) 543
GHB 154 28.36% (24.6%, 32.2%) 389 71.64% (67.8%, 75.4%) 543
Poppers 96 17.68% (14.5%, 20.9%) 447 82.32% (79.1%, 85.5%) 543
Alcohol 64 11.79% (09.1%, 14.5%) 479 88.21% (85.5%, 90.9%) 543
Erectile Enhancers 53 9.76% (07.3%, 12.3%) 490 90.24% (87.7%, 92.7%) 543
Cocaine 34 6.26% (04.2%, 08.3%) 509 93.74% (91.7%, 95.8%) 543
Alcohol to Intoxication 32 6.15% (04.1%, 08.2%) 488 93.85% (91.8%, 95.9%) 520
Ecstasy 20 3.68% (02.1%, 05.3%) 523 96.32% (94.7%, 97.9%) 543
Ketamine 15 2.76% (01.4%, 04.1%) 528 97.24% (95.9%, 98.6%) 543
Sleeping Pills 12 2.33% (01.0%, 03.6%) 503 97.67% (96.4%, 99.0%) 515
Anxiolytics 10 1.84% (00.7%, 03.0%) 533 98.16% (97.0%, 99.3%) 543
Stimulants 7 1.29% (00.3%, 02.2%) 536 98.71% (97.8%, 99.7%) 543
Painkillers 2 0.37% 00.0%, 00.9%) 541 99.63% (99.1%, 100.0%) 543
Inhalants 1 0.19% (00.0%, 00.6%) 519 99.81% (99.4%, 100.0%) 520
Crack 0 0.00% (00.0%, 00.0%) 543 100.00% (100.0%, 100.0%) 543
Rohypnol 0 0.00% (00.0%, 00.0%) 543 100.00% (100.0%, 100.0%) 543
Hallucinogens 0 0.00% (00.0%, 00.0%) 520 100.00% (100.0%, 100.0%) 520
Opiates 0 0.00% (00.0%, 00.0%) 543 100.00% (100.0%, 100.0%) 543
Cough Medicine 0 0.00% (00.0%, 00.0%) 493 100.00% (100.0%, 100.0%) 493
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1

Multiple drugs could be used on the same day with methamphetamine.

2

Total days of methamphetamine use vary for certain drugs because those drugs were not recorded at all visits.

3.7. Comparison to cocaine use

For comparison to other stimulant use among the cohort, cocaine use was more prevalent compared to methamphetamine use. Powder cocaine and crack-cocaine use were reported by 27.4% and 0.6% of the 990 participants, respectively. Demographic characteristics of participants who used powder cocaine were reported by each wave in Supplemental Table 1. The incidence rate for cocaine use throughout the entire cohort study was 8.2 per 100 person-years. While the cumulative incidence was 40.2% for Wave I and 48.6% for Wave II. By race/ethnicity, there was not a significant difference in the average number of days of cocaine use (F=0.66, p=0.6538 for Wave I; F=0.44, p=0.8195 for Wave II). Among participants who reported cocaine use, a higher percentage were born in the U.S. and identified as gay.

4. Discussion

This study contributes to the increasing need for a nuanced, location specific understanding of methamphetamine use within the young SMM population. As one of the first studies to describe methamphetamine use among Millennial SMM in NYC as they age, we found heightened use among populations of color (Native American, Hispanic/Latino, or Black). Consilient with other studies of methamphetamine, the drug was associated with higher gay identity (Bowers et al., 2011; Bowers et al., 2012; Irwin & Morgenstern, 2005; Kann et al., 2011) suggesting higher gay community affiliation (Green & Halkitis, 2006; Prestage et al., 2007), poly drug use (Irwin & Morgenstern, 2005), and social weekend use (Halkitis et al., 2005).

Methamphetamine use data among SMM are inconsistent. A Los Angeles based study reported that Black and White SMM were more likely to use methamphetamine compared to Latino SMM (Wohl et al., 2008). Another found that White NH and Hispanic/Latino were more likely to use stimulants (amphetamine or methamphetamine) compared to Black SMM (Irwin & Morgenstern, 2005). The differences in the racial makeup of SMM who report methamphetamine use may depend on the location of the study (Reback et al., 2013). In our study, the average days of methamphetamine use were largest among Native American/Other NH, Hispanic/Latino, and Black NH participants. These differences in the frequency of methamphetamine use among racial and ethnic minority SMM are important as the intersectionality of sexuality and other demographic characteristics has been found to be associated with sexual behavior, poly-drug use, and HIV testing behaviors (Carrico et al., 2017; Mimiaga et al., 2010).

Sexual identity is a key demographic characteristic for a more nuanced understanding of methamphetamine use. Previous studies have shown that SMM who identify as gay were more likely to use substances compared to SMM who did not identify as gay (Bowers et al., 2011; Bowers et al., 2012; Irwin & Morgenstern, 2005; Kann et al., 2011). This study found that Millennial SMM who identified as gay reported a higher frequency of methamphetamine use compared to those who did not identify as gay. The differences in methamphetamine use may be related to gay community engagement as shown in previous studies (Green & Halkitis, 2006; Halkitis & Parsons, 2002; Prestage et al., 2007).

The collection of the event-level methamphetamine use data allowed for a contextualized understanding of chronic use within the study population. Most of those reporting methamphetamine use may not be chronic users given that the majority of methamphetamine use occurred infrequently and on Friday, Saturday, and Sunday. These findings follow the same patterns of a previous study conducted in New York City (Halkitis et al., 2009). There is an opportunity for interventions targeted at this young population before acute methamphetamine use becomes chronic use, which negatively affects neurocognitive functioning, including memory, motor function, and impulse control (Meredith et al., 2005; Simon et al., 2002; Volkow et al., 2001).

This study found that cannabis and GHB were the drugs most frequently used on days of methamphetamine use. Same-day use of methamphetamine and GHB is an area of concern due to the high risk of adverse effects and overdose, especially for young SMM who recently initiated GHB (Degenhardt et al., 2003; Palamar & Halkitis, 2006). Simultaneous use of methamphetamine and a secondary drug has been associated with a decrease in drug treatment participation (Wang et al., 2017) and adverse health effects, heavy drug use, and death (Barker et al., 2007; Corkery et al., 2018). We found that cocaine use was more prevalent in the cohort compared to methamphetamine use. This is an area for concern given that cocaine is cardiotoxic (Stankowski et al., 2015) and associated with HIV seroconversion (Mayer et al., 2013; Ostrow et al., 2009). Further research on the differences of methamphetamine use and other substances, including cocaine, is needed to better understand drug use patterns among young SMM.

A strength of the present study is the longitudinal data collection that took place every six months through the use of a calendar-based technique. This technique allows for the valid collection of event-level drug use patterns (Hjorthøj et al., 2012), but does have several limitations. Drug use data is self-reported and the study did not record biomarker data to measure recent substance use therefore the data is subject to bias. Furthermore, the data collected in the TLFB fails to capture the other 5 months between assessments, does not differentiate between same-day and simultaneous drug use, and does not record the route of administration for methamphetamine use. Chi-square and ANOVA tests should be interpreted with caution due to the small sample size. Given the sample consists of young SMM in the NYC metropolitan area, our findings may not be generalizable across the nation. Since we did not provide parallel analyses on other substances, future studies directly comparing methamphetamine to other substances among SMM are warranted.

Findings from this study indicate that young Hispanic/Latino, Black, and Native American/Other SMM are using methamphetamine at heightened rates, an issue of concern given the higher prevalence of undiagnosed and unsuppressed HIV viremia in the population (Centers for Disease Control and Prevention, 2019a). Taken together these findings are best understood in the context of syndemic (Halkitis et al., 2013) whereby multiple health burden co-occur particularly in marginalized populations which experience a higher rate of psychosocial stressors. In addition, patterns of use proport a drug that at first may be used for socialization (Halkitis et al., 2005) and sexual activity even with younger SMM, that may also be understood in terms of sexual identity stigma often experienced by men of color (Jerome & Halkitis, 2009). This nuanced description of demographic and behavioral patterns of methamphetamine use of a new generation of young SMM in NYC, provides an opportunity for specific public health and clinical interventions targeted at SMM most at risk of methamphetamine use which can lead to improvements in mental health services (Fletcher et al., 2018) in addition to HIV and STI testing, treatment, and care (Perry N. Halkitis et al., 2014; Halkitis et al., 2001; Hirshfield et al., 2004; Morin et al., 2005; Reback et al., 2018). Further research into the nuances of the motives for polysubstance use and differences in methamphetamine route of administration are needed to better understand drug use among young SMM as well as the possible affects methamphetamine use has on fueling new HIV infections in young SMM. This study is also a call for national surveillance data to truly understand the actual incidence and prevalence of methamphetamine use in the population.

Supplementary Material

Supplemental Table 1

Acknowledgments

Funding: This work was supported by the United States National Institute of Drug Abuse of the National Institute of Health (NIH) [grant numbers 1R01DA0225537, 2R01DA025537].

Footnotes

Declaration of competing interest: None.

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