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Estimated Number of People Who Inject Drugs in the United States
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Clinical Infectious Diseases Jan 2023
Heather Bradley,1 Eric W. Hall,2 Alice Asher,3 Nathan W. Furukawa,3 Christopher M. Jones,4 Jalissa Shealey,1 Kate Buchacz,3 Senad Handanagic,3
Nicole Crepaz,3 and Eli S. Rosenberg5,6
1Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA; 2Oregon Health Sciences University/Portland State University School of Public Health, Portland, Oregon, USA; 3National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 4National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 5Department of Epidemiology and Biostatistics, University at Albany School of Public Health, SUNY, Albany, New York, USA; and 6Office of Public Health, New York State Department of Public Health, Albany, New
We estimated nearly 3.7 million people, or 1.5% of the US adult population, injected drugs in 2018. This estimate is more than 5 times the most recent US estimate of ∼774 000 from 2011 [25]. Much of this increase is likely attributable to increases in IDU, but it is important to consider methodological differences in the creation of this 2018 estimate vs the 2011 estimate. The 2011 estimate was based on self-reported IDU among respondents to household surveys [26], but the present estimate combines available data on substance-specific overdose deaths and treatment admissions with cohort and cross-sectional data collected from known PWID. Applying the same data sources and analytic methods used for the 2018 estimate to 2011 yields an estimated 1.3 million PWID in 2011, which suggest the 2018 estimate is closer to 3 times higher than in 2011. By any measure, these estimates suggest the number of PWID has increased substantially in the U.S. during the past decade.
Abstract
Background
Public health data signal increases in the number of people who inject drugs (PWID) in the United States during the past decade. An updated PWID population size estimate is critical for informing interventions and policies aiming to reduce injection-associated infections and overdose, as well as to provide a baseline for assessments of pandemic-related changes in injection drug use.
Methods
We used a modified multiplier approach to estimate the number of adults who injected drugs in the United States in 2018. We deduced the estimated number of nonfatal overdose events among PWID from 2 of our previously published estimates: the number of injection-involved overdose deaths and the meta-analyzed ratio of nonfatal to fatal overdose. The number of nonfatal overdose events was divided by prevalence of nonfatal overdose among current PWID for a population size estimate.
Results
There were an estimated 3 694 500 (95% confidence interval [CI], 1 872 700-7 273 300) PWID in the United States in 2018, representing 1.46% (95% CI, .74-2.87) of the adult population.
The estimated prevalence of injection drug use was highest among males (2.1%; 95% CI, 1.1-4.2), non-Hispanic Whites (1.8%; 95% CI, .9-3.6), and adults aged 18-39 years (1.8%; 95% CI, .9-3.6).
Conclusions
Using transparent, replicable methods and largely publicly available data, we provide the first update to the number of people who inject drugs in the United States in nearly 10 years. Findings suggest the population size of PWID has substantially grown in the past decade and that prevention services for PWID should be proportionally increased.
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