Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry.
Concurrent stimulant and opioid use
Methamphetamine use
Polydrug use
Rural
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
received:
09
06
2023
accepted:
12
03
2024
medline:
2
4
2024
pubmed:
2
4
2024
entrez:
2
4
2024
Statut:
epublish
Résumé
In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings.
METHODS
METHODS
We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use.
RESULTS
RESULTS
We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment.
CONCLUSION
CONCLUSIONS
In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
Identifiants
pubmed: 38561753
doi: 10.1186/s12954-024-00986-z
pii: 10.1186/s12954-024-00986-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
74Subventions
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044831
Pays : United States
Organisme : NIDA NIH HHS
ID : UH3DA044822
Pays : United States
Organisme : NIDA NIH HHS
ID : UH3DA044822
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044823
Pays : United States
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044829
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044829
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044831
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044831
Pays : United States
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044830
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044829
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044825
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044829
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044823
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044826
Pays : United States
Organisme : NIDA NIH HHS
ID : UG3DA044798
Pays : United States
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Organisme : NIDA NIH HHS
ID : U24DA048538
Pays : United States
Informations de copyright
© 2024. The Author(s).
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