Perceived risk of methamphetamine among Chinese methamphetamine users

Highlights

• Most users perceive methamphetamine to be easily obtainable in China.

• A majority perceived at least moderate risk associated with regular methamphetamine use.

• Perceived risk influences both intentions to use and expectations of desire to use.

• Perceived risk explains demographic differences in intentions to use.

• While addiction was a common risk discussed by users, they were divided in their perceptions.

Abstract

Background

Methamphetamine use has grown considerably in China in recent years. Information about perceptions of risk on methamphetamine is important to facilitate health promotion efforts.

Methods

Using both survey data and qualitative interview data, the authors evaluate the perceived risk of methamphetamine use among Chinese users using a mixed-methods approach. Through Respondent Driven Sampling, the authors recruited a sample of 303 methamphetamine users in Changsha, China.

Results

A majority (59.1%) perceive that infrequent methamphetamine use poses no risk to the user, while 11.2% perceive at least moderate risk for light use. A majority (56.7%) perceived at least moderate risk associated with regular methamphetamine use. Most (82.2%) also perceive methamphetamine to be easily obtainable. A path model indicates that perceived risk shapes intentions to use and expectations of future use, as does perceived availability. Qualitatively, while addiction was the most common risk discussed by users, they differed on whether they perceived the drug addictive. Other concerns raised by interviewees included impaired cognition, mental health problems, physical harm, and social dysfunction.

Conclusion

While some users identify significant risks with methamphetamine, others do not perceive its use to be problematic. Collectively, these findings indicate that intervening upon perceptions of risk among Chinese methamphetamine users may be a means to influence intentions to use.

Introduction

China has witnessed a surge in the use of methamphetamine during the past decade. Methamphetamine, also in the form of tablets known as magu, is domestically produced in China, and the nation has become one of the world's largest methamphetamine markets in recent years (UNODC, 2013). Methamphetamine producing laboratories have increased in number throughout China. Consequently, the use of methamphetamine has increased remarkably during the past decade. Among government registered drug users in 2004, only 1.7% used amphetamines, but the prevalence grew to 11.1% by 2007 and continues to grow (Zhao, 2008). In some regions in China, methamphetamine use has quickly approached levels of heroin use (Huang, Zhang, & Liu, 2011). In this regard, methamphetamine has grown increasingly available in China during this time, yet it remains unclear how methamphetamine users perceive its risk and availability.

Beyond the growing production of methamphetamine, its use is a concern given the harms associated with methamphetamine use and its relatively recent introduction into Chinese drug markets. A range of harms related to the regular use of methamphetamine have been documented widely (Simon et al., 2000, Volkow et al., 2001a, Volkow et al., 2001b), but the evaluation of risks by methamphetamine users in China has not been documented. Perceived risk is a key component in the decision making process related to a range of health behaviors (Janz & Becker, 1984). The perception of risks has been shown to be critical with regard to shaping drug use behaviors (Bachman, Johnston, & O’Malley, 1990). While some studies indicate that perceived risk is most critical for initiation into drug use (Bachman et al., 1990) or current abstinence (Kilmer, Hunt, Lee, & Neighbors, 2007), other studies indicate that perceived risk also plays a role in the behaviors of active drug users. Drug users often consider a range of risks with regard to whether and how they use drugs (Kelly, 2005, White et al., 2006). Studies have indicated that stimulant drugs, such as methamphetamine, often trigger risk perceptions of drug dependence among drug users, yet these are not the only risks that stimulant users consider (White et al., 2006). Risk perceptions are important since they may influence the frequency of drug use as well as shape considerations of abstinence (Carlson, Falck, McCaughn, & Siegal, 2004). Perceived risk is also critical with regard to initiating steps to reduce harm associated with drug use (Bailey et al., 2007, Kelly, 2007).

As methamphetamine is an emerging problem in China, few studies specific to methamphetamine users in China exist, which makes assessments of perceived risk and other factors important. A small study of methamphetamine users in China (n = 74) by Li, Zhang, and Liu (2008), one of the first to specifically report on methamphetamine users in China, indicated that some users experienced fights (22%) or suicidality (23%) after use, and a majority of users (69%) indicated they did not believe methamphetamine use could lead to addiction. Yet, while these findings suggest the experience of harm and low addictive potential, no findings specific to risk perceptions related to methamphetamine use in China have been described in the literature. Despite the evidence related to the influence of risk perceptions on drug use noted above, it remains unclear how methamphetamine users in China understand these risks and whether they perceive any risk associated with their use of this drug. Such a survey of risk perceptions may be useful for those shaping health promotion efforts with this emerging population.

In order to more fully assess the emergence of methamphetamine use in China, we evaluated how Chinese methamphetamine users perceive the level of risk associated with methamphetamine use using a mixed-methods approach. Specifically, we examined survey data with 303 methamphetamine users to ascertain how significant they perceive the risk associated with both limited use of methamphetamine and weekly use of methamphetamine as well as how available they perceive methamphetamine to be. We also assessed how perceived risk impacts other psychological factors – intentions to use and expectations of desire to use–that have been associated with future use. Additionally, we examine qualitative interview data from 40 methamphetamine users to evaluate their considerations of risk. These qualitative data lend texture and depth to the issue of perceived risk, and allow us to more fully illustrate how users think about and discuss risk.