Men who have sex with men (MSM) have higher rates of drug use compared with the general population and are at increased risk of contracting HIV. The United States is currently experiencing an opioid epidemic, but few studies have examined opioid use among MSM. Previous studies have focused on crystal meth, cocaine, and other drugs. We analyzed data from MSM participating in the National HIV Behavioral Surveillance to determine the prevalence of non-injected use of prescription opioids, meth, and cocaine by key characteristics, and to evaluate changes from 2008 to 2014.
Men were recruited using venue-based, time-space sampling in 20 U.S. cities in 2008, 2011, and 2014. Non-injected use of meth, cocaine, and prescription opioids (e.g., Oxycontin, Vicodin, and Percocet) in the past 12 months were self-reported. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated from log-linked Poisson regression models to estimate the change in prevalence of drug use per three-year increase overall, and by demographic group.
Meth use was more frequent among MSM who were white, had lower education and income, lived in Western cities, and were HIV-positive. There were no differences in meth use over time, with 7.8% reporting use in 2008, 6.6% in 2011, and 8.0% in 2014 (P=.76). Cocaine use was more frequent among MSM who were white and ‘other’ race and younger. Cocaine use was also stable over time, although much more frequent than meth use, with 18.6% reporting use in 2008, 16.9% in 2011, and 19.0% in 2014 (P=.75). Opioid use was on par with meth use and was more common among MSM who were white, younger, low education and income, and who lived in Western cities. Opioid use also did not increase overall, with 7.5% reporting use in 2008, 7.7% in 2011, and 7.8% in 2014 (P=.87). However, after adjusting for covariates, increases in opioid use were seen among black MSM (adjusted PR [aPR], 1.24, CI: 1.06-1.45) and those with less education (aPR 1.21, CI: 1.02-1.43) and low income (aPR 1.23, 95% CI: 1.02-1.49).
Overall, there were no changes in reported use of meth, cocaine, and opioids among MSM from 2008 to 2014. Opioid use was as frequent as meth use and is increasing among black MSM and those of low socioeconomic status. HIV prevention interventions need to consider assessing use of opioids and other commonly abused drugs among MSM and offer early treatment for drug dependence to prevent transition to injection.