Co-use of methamphetamine and opioids among people in treatment in Oregon: A qualitative examination of interrelated structural, community, and individual-level factors

López, Andrea; Dhatt, Zena; Howe, Mary; Al-Nassir, Marwa; Billing, Amy; Artigiani, Eleanor; Wish, Eric D.

doi:10.1016/j.drugpo.2020.103098

Cited by 46 publications

(40 citation statements)

References 37 publications

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“…While the prevalence of opioid use has remained high in BC since 2012, the use of crystal meth has steadily increased since 2012, surpassing non-fentanyl opioids in 2017 [ 4 , 20 ]. Opioids and crystal meth are often used at the same time or immediately before or after one another, increasing toxicity and risk of overdose [ 33 , 34 ]. Studies are starting to explore the motivations for using both drugs, such as managing symptoms of withdrawal and desire for an enhanced high [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Opioids and crystal meth are often used at the same time or immediately before or after one another, increasing toxicity and risk of overdose [ 33 , 34 ]. Studies are starting to explore the motivations for using both drugs, such as managing symptoms of withdrawal and desire for an enhanced high [ 34 ]. Future studies can further explore the motivations and pattern of co-use of opioids and crystal meth, in order to target harm reduction and education programs to prevent harms that may arise from this pattern of use.…”

Section: Discussionmentioning

confidence: 99%

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Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Parent

Papamihali

Graham

et al. 2021

Subst Abuse Treat Prev Policy

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Background British Columbia (BC) is in the midst of an opioid overdose crisis. Since 2017, smoking illicit drugs has been the leading mode of drug administration causing overdose death. Yet, little is known about people who smoke opioids, and factors underlying choice of mode of administration. The study objectives are to identify the prevalence and correlates associated with smoking opioids. Methods The Harm Reduction Client Survey is a monitoring tool used by the BC Centre for Disease Control since 2012. This survey is disseminated to harm reduction sites across BC to understand drug use trends and drug-related harms. We examined data from the survey administered October–December 2019 and performed descriptive, univariate, and multivariate analyses to better understand factors associated with smoking opioids. Results A total of 369 people who used opioids in the past 3 days were included, of whom 251 (68.0%) reported smoking opioids. A total of 109 (29.5%) respondents experienced an overdose in the past 6 months; of these 79 (72.5%) smoked opioids. Factors significantly associated with smoking opioids were: living in a small community (AOR =2.41, CI =1.27–4.58), being a woman (AOR = 1.84, CI = 1.03–3.30), age under 30 (AOR = 5.41, CI = 2.19–13.40) or 30–39 (AOR = 2.77, CI = 1.33–5.78) compared to age ≥ 50, using drugs alone (AOR = 2.98, CI = 1.30–6.83), and owning a take-home naloxone kit (AOR = 2.01, CI = 1.08–3.72). Reported use of methamphetamines within the past 3 days was strongly associated with smoking opioids (AOR = 6.48, CI = 3.51–11.96). Conclusions Our findings highlight important correlates associated with smoking opioids, particularly the recent use of methamphetamines. These findings identify actions to better respond to the overdose crisis, such as targeted harm reduction approaches, educating on safer smoking, advocating for consumption sites where people can smoke drugs, and providing a regulated supply of opioids that can be smoked.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Parent

Papamihali

Graham

et al. 2021

Subst Abuse Treat Prev Policy

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“…62 An additional study among treatment staff and patients receiving treatment at two treatment facilities in Oregon identified several individual-level factors contributing to the rise in methamphetamine and opioid use: methamphetamine as a strategy to detoxify or titrate impacts of heroin; financial benefits of methamphetamine to maintain a high; easy access to purchasing heroin and methamphetamine in combination; and methamphetamine being perceived as a safer alternative to heroin. 63 Three additional studies have identified similar motivations for methamphetamine use in the context of heroin or illicit fentanyl. A study exploring overdose risk factors in a sample of people who use drugs in Ohio noted that "a preliminary finding from our current research focusing on methamphetamine suggests the existence of lay beliefs among people who use drugs in Dayton that use of methamphetamine in conjunction with heroin/non-prescribed fentanyl may reduce overdose risk.…”

Section: What Is Known About Motivations For Co-occurring Use Of Meth...mentioning

confidence: 99%

Methamphetamine use in the United States: epidemiological update and implications for prevention, treatment, and harm reduction

Jones

Houry

Han

et al. 2021

Annals of the New York Academy of Sciences

100

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Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices.

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“…Several hypotheses have been suggested to explain this growing trend, including efforts to improve prescribing practices to reduce the availability of opioids 3 which may have resulted in shifts to other substances by PWUO, increased accessibility and popularity coupled with low costs of stimulants, 3 using stimulants to manage or reduce opioid withdrawal symptoms, and co-using stimulants for synergistic euphoric effects. 10,22 When examining the most frequently co-mentioned substances between 2011-2020, we found illicit opioids were more frequently mentioned with illicit stimulants (e.g., heroin and methamphetamine) and prescription opioids were most frequently mentioned with prescription amphetamine-type stimulants (e.g., oxycodone/hydrocodone and Adderall®). This suggests possibly distinct populations within the social media substance use forums we studied with preferences for particular types of substances.…”

Section: Discussionmentioning

confidence: 94%

“…9 Recent ndings also suggest that reasons for co-use, particularly with methamphetamine, are multifaceted-such as ease of access, helping boost the "high", improving daily function (e.g., increasing productivity or staying alert), and helping manage withdrawal symptoms. 10 However, little is known about when stimulants enter into the substance use trajectory of PWUO, how co-use patterns have shifted over recent years, and how patterns of opioid and stimulant co-use evolve at an individual-level. One potential source for gathering exploratory information on this emerging health concern is longitudinal social media data obtained from Reddit.…”

Section: Introductionmentioning

confidence: 99%

Trends in Co-mention of Stimulants and Opioids: A Natural Language Processing Driven Analysis of Reddit Forums

Sarker

Al-Garadi

et al. 2022

Preprint

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BackgroundDespite recent increasing focus on fatal overdoses involving multiple substances, there is a paucity of knowledge about stimulant co-use patterns among people who use opioids (PWUO) or people being treated with medication for opioid use disorder (PTMOUD). This study examines stimulant co-mention trends among PWUO/PTMOUD on social media.MethodsWe collected publicly-available data from 14 prescription and illicit opioid and MOUD-related forums on Reddit (subreddits) between 2011-2020 and timelines comprising past posts from a sample of Reddit users (Redditors) on these forums. We applied natural language processing to detect mentions of opioids, opioid-related medications, and stimulants and described trends and patterns in co-mentions. ResultsPosts collected for 13,812 Redditors indicated 12,306 (89.1%) mentioned ≥1 opioid, opioid-related medication or stimulant. Analyses showed the number and proportion of Redditors mentioning both opioids and/or opioid-related medications and stimulants steadily increased over time. Relative rates of co-mentions of heroin and methamphetamine, substances most commonly co-mentioned, decreased in recent years while those of fentanyl and MOUD with methamphetamine increased. ConclusionData from Reddit reflect increasing mentions of stimulants, particularly methamphetamine, among PWUO/PTMOUD and closely resemble the growth in overdose deaths involving both opioids and stimulants. These findings are consistent with recent reports suggesting increasing stimulant use among people receiving treatment for opioid use disorder. These data offer insights on emerging trends in the overdose epidemic and underscore the importance of scaling efforts to address co-occurring opioid and stimulant use including harm reduction and comprehensive healthcare access spanning mental-health services and substance use disorder treatment.

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Co-use of methamphetamine and opioids among people in treatment in Oregon: A qualitative examination of interrelated structural, community, and individual-level factors

Cited by 46 publications

References 37 publications

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected

Methamphetamine use in the United States: epidemiological update and implications for prevention, treatment, and harm reduction

Trends in Co-mention of Stimulants and Opioids: A Natural Language Processing Driven Analysis of Reddit Forums

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