title: Patterns of drug use, risky behavior, and health status among persons who inject drugs living in San Diego, California: a latent class analysis.
abstract: BACKGROUND
  Among persons who inject drugs (PWID), polydrug use (the practice of mixing multiple drugs/alcohol sequentially or simultaneously) increases risk for HIV transmission and unintentional overdose deaths. Research has shown local drug markets influence drug use practices. However, little is known about the impact of drug mixing in markets dominated by black tar heroin and methamphetamine, such as the western United States.
  
  
  METHODS
  Data were collected through an ongoing longitudinal study examining drug use, risk behavior, and health status among PWID. Latent class analysis (LCA) was used to identify patterns of substance use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple administration routes (injecting, smoking, and swallowing). Logistic regression was used to identify behaviors and health indicators associated with drug use class.
  
  
  RESULTS
  The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all P-values < .05).
  
  
  CONCLUSIONS
  Risk behaviors and health outcomes differed between PWID who primarily inject heroin vs. those who use methamphetamine. The findings suggest that in a region where PWID mainly use black tar heroin or methamphetamine, interventions tailored to sub-populations of PWID could improve effectiveness.
authors.affiliation: 1Drexel University, Philadelphia , Pennsylvania , USA.
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Roth
authors.forename: Richard A
authors.initials: RA
authors.lastname: Armenta
authors.forename: Karla D
authors.initials: KD
authors.lastname: Wagner
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roesch
authors.forename: Ricky N
authors.initials: RN
authors.lastname: Bluthenthal
authors.forename: Jazmine
authors.initials: J
authors.lastname: Cuevas-Mota
authors.forename: Richard S
authors.initials: RS
authors.lastname: Garfein
mesh_terms: D000328:Adult; D002140:California; D004333:Drug Administration Routes; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006304:Health Status; D003932:Heroin / Q000008:administration & dosage; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage; D008875:Middle Aged; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*
chemical_list: D008694:Methamphetamine; D003932:Heroin
keywords: California; San Diego; latent class analysis; persons who inject drugs; polydrug use; tailored interventions