Compared to Puerto Rican PWID in New York City, those in San Juan are more likely to use injection heroin, cocaine, and speedball and less likely to use non-injection substances such marijuana, alcohol, and non-injectable heroin and cocaine ( Colon et al., 2001). born Hispanics, Puerto Rican born Hispanics are more likely to use injection heroin and speedball and less likely to inject amphetamines ( Freeman et al., 1999). Simultaneous use of heroin and cocaine (i.e., speedball) is highly prevalent among Puerto Rican PWID ( Colon et al., 2001). These factors may explain higher risks of overdose and HIV and HCV infection among polysubstance using PWID when compared to PWID who use a limited range of substances ( Harrell et al., 2012 Keen et al., 2014). In general, polysubstance use among PWID has been associated with distinct physical and mental health comorbidities ( Betts et al., 2016 Patra et al., 2009), increased injection and sexual risk behaviors ( Harrell et al., 2012 Meacham et al., 2015), and poorer treatment outcomes ( Dutra et al., 2008). Polysubstance use is understood as the consumption of two or more substances during a specified time period, including simultaneous use of multiple substances in a single occasion or concurrent use of multiple substances on separate occasions within a short period of time ( Ives and Ghelani, 2006). This study uses latent class analysis (LCA) to examine weekly injection and non-injection polysubstance use profiles across comparable rural and urban samples of active PWID in Puerto Rico to determine how and when rural and urban substance use and injection risk differ. suggests a need for research in rural areas ( Dombrowski et al., 2016). Within Puerto Rico, internal differences in use patterns, overdose risk, and service need-especially urban/rural differences-are not well known, while the growth in injection opioid use in rural communities elsewhere in the U.S. Comparative research in the San Juan metropolitan area and New York City shows that people who inject drugs (PWID) in San Juan use injection drugs more often and engage in riskier injection behaviors compared to Puerto Ricans on the mainland ( Colon et al., 2001). This is particularly evident among Puerto Ricans, who despite lower overall rates of lifetime illicit substance use ( Canino, 2007), display higher rates of substance use-related health consequences such as HIV and hepatitis C (HCV Mino et al., 2011). Patterns of substance use and related health risks differ considerably across substances and geographic locations ( Colon et al., 2001 Deren et al., 2003).
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