Prevalence of adults with stimulant misuse and/or stimulant use disorder in Massachusetts, USA, 2014-2021.

Background and aims: Stimulant-involved overdose deaths are increasing throughout the United States. Because stimulant misuse (i.e. taking a prescribed medicine not as directed) and stimulant use disorder contribute to the surging number of stimulant-related deaths, knowing the prevalence of stimulant misuse and use disorder is important. We aimed to estimate the prevalence of stimulant misuse and/or use disorder in Massachusetts from 2014 to 2021.

Design, setting and participants: This was a cohort study using a multiple systems estimation approach (previously known as 'capture-recapture'), using multiple individually linked epidemiological data sources, located in the Commonwealth of Massachusetts, 2014-2021. People aged 18-64 years from administrative databases were linked at the individual level and included in the analysis.

Measurements: Measurements included known and estimated counts of people with stimulant misuse and/or use disorder (as defined in each individual database) as well as total count and prevalence in Massachusetts. We performed both a stratified analysis using log-linear models to estimate the unknown population with stimulant misuse/use disorder and a single model analysis in which demographics were used as covariates. Uncertainty is characterized using 95% confidence intervals (95% CI) on the total counts and prevalence estimates.

Findings: The number of known individuals increased during the study period from 31 037 in 2014 to 42 612 in 2021. Using the multiple systems estimation approach, the estimated prevalence of underlying stimulant misuse and/or use disorder population ranged from 4.1 to 7.1% during the study period in the stratified analysis and 4.2 to 6.8% in the single model. By race, the highest prevalence estimates were among the Black non-Hispanic population, which showed a prevalence of up to 14.5% (95% CI = 14.32%, 14.57%) in 2021.

Conclusions: The estimated prevalence of stimulant misuse and/or use disorder in Massachusetts from 2014 to 2021 ranged from 4% to nearly 7% of the population. People from racial minorities appear to be disproportionately affected compared with the white non-Hispanic population. The unknown population accounted for large proportions of the total estimated population.