Journal of Urban Health

, Volume 85, Issue 2, pp 239–249 | Cite as

Tripling of Methamphetamine/Amphetamine Use among Homeless and Marginally Housed Persons, 1996–2003

  • Moupali Das-DouglasEmail author
  • Grant Colfax
  • Andrew R. Moss
  • David R. Bangsberg
  • Judith A. Hahn


Methamphetamine/amphetamine (MA)-related morbidity and mortality has been increasing in the United States. MA use is associated with high-risk sexual behavior and syringe-sharing practices. Homeless and marginalized housed persons (H/M) have high rates of substance use and mental health disorders. Little is known about trends of MA use among the H/M. The objective of this study was to quantify increases in MA use among H/M in San Francisco and to determine which demographic and behavioral subgroups have experienced the greatest increases in MA use. We conducted serial cross-sectional population-based studies in three waves: 1996–1997, 1999–2000, and 2003 and studied 2,348 H/M recruited at shelters and lunch lines. The main outcome was self-reported current (30-day) MA use. We found a tripling of current MA use among H/M persons from 1996 to 2003, with a sevenfold increase in smoked MA use. MA use doubled to tripled in most demographic and behavioral subgroups, whereas it quadrupled in those under age 35, and there was a fivefold increase among HIV-infected persons. The increase in MA use among H/M places a vulnerable population at additional increased risk for HIV infection and MA-use related morbidity and mortality. Among HIV-infected H/M, the increase in MA use has important public health implications for the development and secondary transmission of drug-resistant HIV caused by synergistic neurocognitive decline, poor adherence to HIV medications, and increased sexual risk behavior. Clinicians caring for H/M persons should inquire about MA use, refer interested MA users to MA dependence treatment programs and provide targeted HIV sexual risk reduction counseling. For HIV-infected H/M MA users, clinicians should closely monitor adherence to HIV or other chronic medications, to avoid unnecessary morbidity and mortality. Further research is needed to elucidate the most effective prevention and treatment for MA use and dependence among the H/M.


Methamphetamine Amphetamine Speed Homeless Marginally housed HIV/AIDS 



MD-D is supported by T-32 MH19105. DRB supported by NIH K-24 AA015287. JH supported by NIH K01 DA023365. The research was supported by NIH R01 MH54907. The funding agencies had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

Financial Disclosures

None of the authors report any financial relationships or other conflicts of interest.


  1. 1.
    Methamphetamine use dates to post-WWII era. Drug little-known risk factor in early AIDS days. AIDS Alert. 2002;17(10):125–127.Google Scholar
  2. 2.
    SAMHSA. Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004. Washington D.C.: SAMSHA; 2005.Google Scholar
  3. 3.
    Increasing morbidity and mortality associated with abuse of methamphetamine—United States, 1991–1994. MMWR Morb Mortal Wkly Rep. 1995;44(47):882–886.Google Scholar
  4. 4.
    Treatment Episode Data Set (TEDS). Highlights—2003. National Admissions to Substance Abuse Treatment Services. DASIS Series: S-27. 2005 (DHHS Publication No. (SMA) 05-4043). Available at: Accessed on August 14, 2007.
  5. 5.
    Roberts DL, Ball J. Amphetamine and Methamphetamine Emergency Department Visits, 1995–2002 The Drug Abuse Warning Network. The DAWN Report. July 2004. Available at: Accessed on August 14, 2007.
  6. 6.
    Brecht ML, Greenwell L, Anglin MD. Methamphetamine treatment: trends and predictors of retention and completion in a large state treatment system (1992–2002). J Subst Abuse Treat. 2005;29(4):295–306.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnston LD, O’Malley PM, Bachman JG. Monitoring the Future: National Survey Results on Drug Use, 1975–2002, Volume II: College Students & Adults Ages 19–40. National Institute on Drug Abuse; 2002.Google Scholar
  8. 8.
    Iritani BJ, Hallfors DD, Bauer DJ. Crystal methamphetamine use among young adults in the USA. Addiction. 2007;102(7):1102–1113.PubMedCrossRefGoogle Scholar
  9. 9.
    Mansergh G, Colfax GN, Marks G, Rader M, Guzman R, Buchbinder S. The Circuit Party Men’s Health Survey: findings and implications for gay and bisexual men. Am J Public Health. 2001;91(6):953–958.PubMedGoogle Scholar
  10. 10.
    Shoptaw S, Peck J, Reback CJ, Rotheram-Fuller E. Psychiatric and substance dependence comorbidities, sexually transmitted diseases, and risk behaviors among methamphetamine-dependent gay and bisexual men seeking outpatient drug abuse treatment. J Psychoactive Drugs. 2003;35(Suppl 1):161–168.PubMedGoogle Scholar
  11. 11.
    Schwarcz S, Scheer S, McFarland W, et al. Prevalence of HIV infection and predictors of high-transmission sexual risk behaviors among men who have sex with men. Am J Public Health; 2007;97(6):1067–1075 (Jun).Google Scholar
  12. 12.
    Colfax G, Coates TJ, Husnik MJ, et al. Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. J Urban Health. 2005;82(Suppl 1):i62–i70.PubMedGoogle Scholar
  13. 13.
    Colfax G, Vittinghoff E, Husnik MJ, et al. Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol. 15 2004;159(10):1002–1012.PubMedCrossRefGoogle Scholar
  14. 14.
    Wong W, Chaw JK, Kent CK, Klausner JD. Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002–2003. Sex Transm Dis. 2005;32(7):458–463.PubMedCrossRefGoogle Scholar
  15. 15.
    Hirshfield S, Remien RH, Walavalkar I, Chiasson MA. Crystal methamphetamine use predicts incident STD infection among men who have sex with men recruited online: a nested case-control study. J Med Internet Res. 29 2004;6(4):e41.PubMedCrossRefGoogle Scholar
  16. 16.
    Semple SJ, Zians J, Grant I, Patterson TL. Impulsivity and methamphetamine use. J Subst Abuse Treat. 2005;29(2):85–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Semple SJ, Zians J, Grant I, Patterson TL. Methamphetamine use, impulsivity, and sexual risk behavior among HIV-positive men who have sex with men. J Addict Dis. 2006;25(4):105–114.PubMedCrossRefGoogle Scholar
  18. 18.
    Hirshfield S, Remien RH, Humberstone M, Walavalkar I, Chiasson MA. Substance use and high-risk sex among men who have sex with men: a national online study in the USA. AIDS Care. 2004;16(8):1036–1047.PubMedCrossRefGoogle Scholar
  19. 19.
    Chesney MA, Koblin BA, Barresi PJ, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE Study. Am J Public Health. 2003;93(6):933–938.PubMedGoogle Scholar
  20. 20.
    Plankey MW, Ostrow DG, Stall R, et al. The Relationship Between Methamphetamine and Popper Use and Risk of HIV Seroconversion in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. 1 2007;45(1):85–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. West J Med. 1998;168(2):93–97.PubMedGoogle Scholar
  22. 22.
    Lorvick J, Martinez A, Gee L, Kral AH. Sexual and injection risk among women who inject methamphetamine in San Francisco. J Urban Health. 2006;83(3):497–505.PubMedCrossRefGoogle Scholar
  23. 23.
    Gibson DR, Leamon MH, Flynn N. Epidemiology and public health Consequences of methamphetamine use in California’s Central Valley. J Psychoact Drugs. 2002;34(3):313–319.Google Scholar
  24. 24.
    Kushel MB, Hahn JA, Evans JL, Bangsberg DR, Moss AR. Revolving doors: imprisonment among the homeless and marginally housed population. Am J Public Health. 2005;95(10):1747–1752.PubMedCrossRefGoogle Scholar
  25. 25.
    Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002;92(5):778–784.PubMedCrossRefGoogle Scholar
  26. 26.
    Cheung AM, Hwang SW. Risk of death among homeless women: a cohort study and review of the literature. CMAJ. 2004;170(8):1243–1247.PubMedGoogle Scholar
  27. 27.
    Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000;283(16):2152–2157.PubMedCrossRefGoogle Scholar
  28. 28.
    Breakey WR, Fischer PJ, Kramer M, et al. Health and mental health problems of homeless men and women in Baltimore. JAMA. 1989;262(10):1352–1357.PubMedCrossRefGoogle Scholar
  29. 29.
    Wenzel SL, Ebener PA, Koegel P, Gelberg L. Drug-abusing homeless clients in California’s substance abuse treatment system. J Psychoactive Drugs . 1996;28(2):147–159.PubMedGoogle Scholar
  30. 30.
    Mattison AM, Ross MW, Wolfson T, Franklin D. Circuit party attendance, club drug use, and unsafe sex in gay men. J Subst Abuse. 2001;13(1–2):119–126.PubMedCrossRefGoogle Scholar
  31. 31.
    Halkitis PN, Green KA, Mourgues P. Longitudinal investigation of methamphetamine use among gay and bisexual men in New York City: findings from Project BUMPS. J Urban Health. 2005;82(Suppl 1):i18–i25.PubMedGoogle Scholar
  32. 32.
    Semple SJ, Patterson TL, Grant I. A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men. Drug Alcohol Depend. 2004;76(2):203–212.PubMedCrossRefGoogle Scholar
  33. 33.
    Newmeyer JA. The prevalence of drug use in San Francisco in 1987. J Psychoactive Drugs. 1988;20(2):185–189.PubMedGoogle Scholar
  34. 34.
    Newmeyer JA. Patterns and trends of drug use in the San Francisco Bay Area. J Psychoact Drugs. 2003;35(Suppl 1):127–132.Google Scholar
  35. 35.
    Fairbairn N, Kerr T, Buxton JA, Li K, Montaner JS, Wood E. Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting. Drug Alcohol Depend. 11 2007;88(2–3):313–316.PubMedCrossRefGoogle Scholar
  36. 36.
    Burnam M, Koegel P. Methodology for obtaining a representative sample of homeless persons. Eval. Rev. 1988;12:117–152.CrossRefGoogle Scholar
  37. 37.
    Robertson MJ, Clark RA, Charlebois ED, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–1217.PubMedGoogle Scholar
  38. 38.
    Hahn JA, Kushel MB, Bangsberg DR, Riley E, Moss AR. BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco. J Gen Intern Med. 2006;21(7):775–778.PubMedCrossRefGoogle Scholar
  39. 39.
    Mantel N. Chi-square tests with one degree of freedom: extensions of the Mantel-Haenszel procedure. J Am Stat Assoc. 1963;58:690–700.CrossRefGoogle Scholar
  40. 40.
    Colfax GN, Vittinghoff E, Grant R, Lum P, Spotts G, Hecht FM. Frequent methamphetamine use is associated with primary non-nucleoside reverse transcriptase inhibitor resistance. AIDS. 2007;21(2):239–241.PubMedCrossRefGoogle Scholar
  41. 41.
    Meredith CW, Jaffe C, Ang-Lee K, Saxon AJ. Implications of chronic methamphetamine use: a literature review. Harv Rev Psychiatr. 2005;13(3):141–154.CrossRefGoogle Scholar
  42. 42.
    Maxwell JC. Emerging research on methamphetamine. Curr Opin Psychiatry. 2005;18(3):235–242.PubMedCrossRefGoogle Scholar
  43. 43.
    Curtis EK. Meth mouth: a review of methamphetamine abuse and its oral manifestations. Gen Dent. 2006;54(2):125–129; quiz 130.PubMedGoogle Scholar
  44. 44.
    Saini T, Edwards PC, Kimmes NS, Carroll LR, Shaner JW, Dowd FJ. Etiology of xerostomia and dental caries among methamphetamine abusers. Oral Health Prev Dent. 2005;3(3):189–195.PubMedGoogle Scholar
  45. 45.
    Williams N, Covington JS, 3rd. Methamphetamine and meth mouth: an overview. J Tenn Dent Assoc. 2006;86(4):32–35.PubMedGoogle Scholar
  46. 46.
    Tominaga GT, Garcia G, Dzierba A, Wong J. Toll of methamphetamine on the trauma system. Arch Surg. 2004;139(8):844–847.PubMedCrossRefGoogle Scholar
  47. 47.
    Rippeth JD, Heaton RK, Carey CL, et al. Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. J Int Neuropsychol Soc. 2004;10(1):1–14.PubMedCrossRefGoogle Scholar
  48. 48.
    Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care. 2003;15(6):775–785.PubMedCrossRefGoogle Scholar
  49. 49.
    Obert JL, McCann MJ, Marinelli-Casey P, et al. The matrix model of outpatient stimulant abuse treatment: history and description. J Psychoact Drugs. 2000;32(2):157–164.Google Scholar
  50. 50.
    Rawson RA, Marinelli-Casey P, Anglin MD, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction. 2004;99(6):708–717.PubMedCrossRefGoogle Scholar
  51. 51.
    Rawson RA, Gonzales R, Brethen P. Treatment of methamphetamine use disorders: an update. J Subst Abuse Treat. 2002;23(2):145–150.PubMedCrossRefGoogle Scholar
  52. 52.
    Rawson RA, Huber A, Brethen P, et al. Status of methamphetamine users 2–5 years after outpatient treatment. J Addict Dis. 2002;21(1):107–119.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2007

Authors and Affiliations

  • Moupali Das-Douglas
    • 1
    • 2
    • 3
    Email author
  • Grant Colfax
    • 4
  • Andrew R. Moss
    • 5
  • David R. Bangsberg
    • 1
    • 2
    • 3
  • Judith A. Hahn
    • 2
  1. 1.Department of Medicine, Division of Infectious DiseasesUniversity of CaliforniaSan FranciscoUSA
  2. 2.Epidemiology and Prevention Interventions Center, Department of Medicine, San Francisco General HospitalUniversity of CaliforniaSan FranciscoUSA
  3. 3.Center for AIDS Prevention StudiesUniversity of CaliforniaSan FranciscoUSA
  4. 4.Epidemiology Section, AIDS OfficeSan Francisco Department of Public HealthSan FranciscoUSA
  5. 5.Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations