• Four distinct stimulant use trajectories were identified over 12 months. • High stimulant use was associated with recent overdose and being unhoused. • Powder cocaine showed a unique declining pattern of use. • Diagnosed psychosis was associated with more days of recent stimulant use ( p < 0.05). • Findings may inform the design of tailored harm reduction interventions. Overdoses in the United States are increasingly driven by co-occurring stimulant and fentanyl use, yet limited research has examined individual-level stimulant use patterns over time. We assessed self-reported stimulant use among 505 people who use drugs enrolled in the Rhode Island Prescription and Illicit Drug Study (RAPIDS) from 2020 to 2024. Group-based trajectory modeling identified distinct patterns of past-month stimulant use over 12 months of follow-up. We examined associations between trajectories and sociodemographic characteristics, other substance use patterns, and mental health diagnoses. Four distinct stimulant use trajectories emerged: low (12%), low/moderate (52%), moderate/high (19%), and high (17%) use. The high-use group exhibited the highest proportion of people who were unhoused (82%, p < 0.01) and had injected drugs in the past month (42%, p < 0.01) at baseline. The high-use group also reported the highest proportions of a lifetime diagnosis of bipolar disorder (46%, p = 0.05), anxiety disorder (57%, p < 0.01), and psychosis (25%, p < 0.01) at baseline. Trajectory-based analyses by specific stimulant type revealed that powder cocaine decreased at three months compared to baseline, while other stimulant use (i.e., crack cocaine, crystal methamphetamine, extra-medical prescription stimulants) remained relatively stable over follow-up. Findings underscore the need for prevention and harm reduction-focused interventions in settings that serve people who are unhoused (e.g., living in homeless shelters, transitional programs) and those with diagnosed psychosis (e.g., receiving behavioral and mental health services).
Shaw et al. (Thu,) studied this question.