Analyzing and predicting short-term substance use behaviors of persons who use drugs in the great plains of the U.S

Background: Substance use induces large economic and societal costs in the U.S. Understanding the change in substance use behaviors of persons who use drugs (PWUDs) over time, therefore, is important in order to inform healthcare providers, policymakers, and other stakeholders toward more efficient allocation of limited resources to at-risk PWUDs.

Objective: This study examines the short-term (within a year) behavioral changes in substance use of PWUDs at the population and individual levels.

Methods: 237 PWUDs in the Great Plains of the U.S. were recruited by our team. The sample provides us longitudinal survey data regarding their individual attributes, including drug use behaviors, at two separate time periods spanning 4-12 months. At the population level, we analyze our data quantitatively for 18 illicit drugs; then, at the individual level, we build interpretable machine learning logistic regression and decision tree models for identifying relevant attributes to predict, for a given PWUD, (i) which drug(s) they would likely use and (ii) which drug(s) they would likely increase usage within the next 12 months. All predictive models were evaluated by computing the (averaged) Area under the Receiver Operating Characteristic curve (AUROC) and Area under the Precision-Recall curve (AUPR) on multiple distinct sets of hold-out sample.

Results: At the population level, the extent of usage change and the number of drugs exhibiting usage changes follow power-law distributions. At the individual level, AUROC's of the models for the top-4 prevalent drugs (marijuana, methamphetamines, amphetamines, and cocaine) range 0.756-0.829 (+2.88-7.66% improvement with respect to baseline models using only current usage of the respective drugs as input) for (i) and 0.670-0.765 (+4.34-18.0%) for (ii). The corresponding AUPR's of the said models range 0.729-0.947 (+2.49-13.6%) for (i) and 0.348-0.618 (+26.9-87.6%) for (ii).

Conclusion: The observed qualitative changes in short-term substance usage and the trained predictive models for (i) and (ii) can potentially inform human decision-making toward efficient allocation of appropriate resources to PWUDs at highest risk.