Trends in Indicators of Injection Drug Use, Indian Health Service, 2010-2014 A Study of Health Care Encounter Data

• Published in: Public health reports (1974) Vol. 135; no. 4; pp. 461 - 471
• Main Authors: Evans, Mary E., Person, Marissa, Reilley, Brigg, Leston, Jessica, Haverkate, Richard, McCollum, Jeffrey T., Apostolou, Andria, Bohm, Michele K., Van Handel, Michelle, Bixler, Danae, Mitsch, Andrew J., Haberling, Dana L., Hatcher, Sarah M., Weiser, Thomas, Elmore, Kim, Teshale, Eyasu H., Weidle, Paul J., Peters, Philip J., Buchacz, Kate
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Sage Publications, Inc 01-07-2020; SAGE Publications
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alaska Natives - statistics & numerical data; Female; Forecasting; Hepatitis C - epidemiology; Humans; Indians, North American - statistics & numerical data; Male; Middle Aged; Opioid-Related Disorders - epidemiology; Substance Abuse, Intravenous - epidemiology; United States - epidemiology; United States Indian Health Service - statistics & numerical data; United States Indian Health Service - trends; Young Adult; United States; opioid use disorder; American Indian/Alaska Native; HIV; hepatitis C; injection drug use
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/0033354920937284

Objectives
Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known.
Methods
We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged ≥18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis.
Results
Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged ≥50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD.
Conclusions
Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.