Prevalence differences in lifetime methamphetamine and heroin use among American Indian reservation youth from 2015...

Early use of methamphetamine and heroin are associated with severe consequences. American Indian (AI) youth are often portrayed as the highest risk ethnic group in the United States for early use of methamphetamine and heroin, but little empirical evidence supports this. We aimed to examine odds of lifetime methamphetamine and heroin use among the largest representative sample of reservation-area Indigenous youth in the United States, comparing males and females as well as mono-ethnic AI (AI-mono) youth with mono-ethnic non-AI (NAI-mono), multiethnic AI (AI-multi) and multiethnic non-AI (NAI-multi) youth pre- and post-COVID-19 pandemic.

Annual cross-sectional epidemiological surveys were conducted from 2016 to 2024, and comparisons were made between successive cross-sectional samples.

176 schools on or near AI reservations in the contiguous United States were sampled.

The sample consisted of 28.6% NAI-mono, 38.0%, AI-mono, 24.4% AI-multi and 8.8% NAI-multi youth (n = 50 779; mean age = 14.77; 50.5% male).

Lifetime use of methamphetamine and heroin were assessed via survey items regarding ever having used these substances.

Overall, 2.4% of participants reported lifetime methamphetamine use, and 1.8% reported lifetime heroin use. Prevalence of lifetime methamphetamine use was statistically significantly lower post-COVID-19 [pre-COVID-19 = 3.5%, post-COVID-19 = 1.1%; odds ratio (OR) = 4.13, 95% confidence interval (CI) = 2.72-6.27, P < 0.001]. Regression models revealed pre-COVID-19, males were 1.43 times (P < 0.001) more likely than females to have used methamphetamine and 1.56 times (P < 0.001) more likely to have used heroin. NAI-mono youth were statistically significantly less likely to have used methamphetamine compared with AI-mono youth (OR = 0.74, P = 0.02); however, AI-multi youth were statistically significantly more likely to have used methamphetamine (OR = 1.38, P = 0.01) and heroin (OR = 1.84, P < 0.001) compared with AI-mono youth pre-pandemic. Post-COVID-19, males were 1.77 times (P < 0.001) more likely to have used heroin than females, and AI-multi youth were significantly more likely to have used methamphetamine compared with AI-mono (OR = 2.34, P < 0.001) and NAI-mono (OR = 2.50, P < 0.001) youth as well as heroin compared with AI-mono (OR = 1.52, P = 0.03).

Among United States reservation-area Indigenous youth, use of methamphetamine and heroin was lower after the COVID-19 pandemic than before it; however, multi-ethnic American Indian youth are statistically significantly more likely to have used methamphetamine and heroin than mono-ethnic American Indian youth and mono-ethnic non-American Indian youth. Male youth are also at greater risk for lifetime use, supporting the need for targeted interventions for male and multiethnic American Indian youth.