Correlates of concurrent use of stimulants and opioids among people who access harm reduction services in British Columbia, Canada: Findings from the 2019 Harm Reduction Client Survey

Lukac, Christine D; Steinberg, Abigail; Papamihali, Kristi; Mehta, Amiti; Lock, Kurt; Buxton, Jane A.

doi:10.1016/j.drugpo.2022.103602

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…In addition, this study found that homelessness, psychiatric co-morbidity, late-onset heroin use, injection drug use, and past 30-day arrest episodes were associated with a higher probability of heroin-methamphetamine admissions [17 ▪ ]. The findings of Friedman & Shover [25 ▪ ] are also in contrast with those of Lukac et al [35 ▪ ], who found that among individuals using stimulants and/or opioids simultaneously, the probability of simultaneous use of stimulants and opioids decreased with 3% for every one-year increase in age (aOR = 0.97), i.e. younger opioid users were more likely than older opioid users to also use stimulants.…”

Section: Predictors Of Polydrug Use In Opioid Usersmentioning

confidence: 55%

“…younger opioid users were more likely than older opioid users to also use stimulants. This study also found that simultaneous use of stimulants and opioids was negatively associated with paid work (aOR = 0.58) and stable housing (aOR = 0.61) [35 ▪ ]. In a 30-year retrospective cohort study, it was shown that between 1991 and 2020, the time between the initiation of opioid and stimulant use steadily decreased from 6.8 years between exposures in 1991–1995 to 1.5 years in 2016–2020 [56 ▪ ].…”

Section: Predictors Of Polydrug Use In Opioid Usersmentioning

confidence: 60%

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Predictors and motives of polydrug use in opioid users. A narrative review

Amsterdam

Pierce

Brink

2023

Current Opinion in Psychiatry

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Purpose of reviewTo review the recent literature on predictors and personal motives of polydrug use in opioid users with a focus on combined use of opioids with stimulants, benzodiazepines and gabapentinoids.Recent findingsIn North America, methamphetamine is now the most prevalent co-drug in opioid users and is responsible for high mortality rates. In Europe, opioids are rather combined with either cocaine, benzodiazepines or gabapentionoids, but recent data are lacking.Main personal motives of opioid users to combine opioids with methamphetamine or cocaine is to boost the opioid high, inhibit the withdrawal effects of heroin and have a cheaper alternative to maintain the opioid high. Risk factors of polydrug use by opioid users included being male, younger age, homelessness, high-risk sexual behavior, needle sharing, incarceration, poor mental health and recent use of cocaine or prescription opioids. The motives for co-use of opioids and gabapentinoids also include seeking a better high, lower price and to self-medicate pain/physical symptoms, including those resulting from withdrawal.SummaryWhen treating opioid users with polydrug drug use, special attention should be paid to dosing when in opioid agonist methadone/buprenorphine treatment and to the presence of physical pain. The validity of part of the personal motives seems questionable which deserves attention when counselling opioid users with polydrug use.

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Section: Predictors Of Polydrug Use In Opioid Usersmentioning

confidence: 55%

Section: Predictors Of Polydrug Use In Opioid Usersmentioning

confidence: 60%

Predictors and motives of polydrug use in opioid users. A narrative review

Amsterdam

Pierce

Brink

2023

Current Opinion in Psychiatry

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“…People who concurrently use methamphetamine and opioids appear to be a growing population in BC [ 7 ] and among people who use drugs more broadly in North America. It is important that the unique risks of concurrent methamphetamine and opioid use, especially in the context of an unregulated illicit drug supply, be well communicated to people who use these substances.…”

Section: Discussionmentioning

confidence: 99%

“…The most common self-reported reasons for concurrent use were self-medication, availability and preference, drug effects/properties, and financial or life situation [ 6 ]. Although people who use opioids and methamphetamine concurrently are also more likely to own take-home naloxone kits, use observed consumption sites, and prescribe opioid agonist treatment (OAT), risks associated with the illicit drug supply persist [ 7 ]. For example, a recent study found that people who used stimulants and opioids concurrently in BC were more likely to experience an opioid overdose compared to people who used opioids alone[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying behaviours for survival and wellness among people who use methamphetamine with opioids in British Columbia: a qualitative study

et al. 2022

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Background British Columbia (BC) has been in a state of public health emergency since 2016, due to the unprecedented numbers of fatal and non-fatal drug toxicity (i.e. overdose) events. Methamphetamine detection in illicit drug toxicity deaths increased from 14% in 2012 to 43% in 2020 suggesting a concerning trend of concurrent methamphetamine and opioid use in BC, consistent with rising patterns identified across North America. People who use methamphetamine concurrently with opioids face an elevated risk of harm. This study aimed to identify behaviours for survival and wellness practiced by people who concurrently use methamphetamine and opioids. Methods One-on-one semi-structured interviews were conducted by peer research assistants in person and by telephone. Thematic analysis was carried out to identify patterns in behaviours participants described as important to their safety in the context of concurrent use of methamphetamine and opioids. Results Participants (n = 22) were distributed across the province with at least four participants from each of the five geographic health regions: 64% self-identified as men, and 50% self-identified as Indigenous. Daily methamphetamine use was reported by 72.7% of participants, and 67.3% reported using alone either often or always. Participants made several considerations and adaptations in order to balance the perceived benefits and risks of their use of methamphetamine with opioids. Two overarching themes were identified to describe how participants adapted their use for survival and wellness. The first was personal safety behaviours which included self-regulation and self-care behaviours. The second was interpersonal safety behaviours which included using alongside peers, and engaging with peer-led services (e.g. community outreach organizations) and public health-led services (e.g. overdose prevention sites) to reduce the risk of harm. Participants identified many gaps in available services to meet their diverse needs. Conclusions This manuscript identified diversity in participants’ methamphetamine and opioid use (i.e. frequency, route of administration), and a range of behaviours that were performed to improve wellness and survival while using methamphetamine and opioids. Harm reduction and treatment responses must be robust and adaptable to respond to the diversity of patterns of substance use among people who use methamphetamine and opioids concurrently, so as to not perpetuate harm and leave people behind.

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“…Furthermore, studies have suggested that the concurrent use of opioids and stimulants is common among people who access harm reduction sites in BC [10]. Motivations for co-use have been described in a variety of studies, and have ranged from social influences, to seeking to reduce opioid withdrawal, to imrpvoing functionality, energy, or wakefulness [11][12][13]. One study has also revealed a dangerous misperception among people who co-use opioids and stimulants, that stimulants can have a protective against opioid overdose [14].…”

Section: Introductionmentioning

confidence: 99%

Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

et al. 2022

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Background Stimulant use has been rising among people with opioid use disorder in recent years in North America, alongside a parallel rise in illicit drug toxicity (overdose) deaths. This study aimed to examine the association between stimulant use and overdose mortality. Methods Data from a universal health insurance client roster were used to identify a 20% random general population sample (aged ≥12) in British Columbia, Canada between January 1 2015 and December 31 2018 (N = 1,089,682). Provincial health records were used to identify people who used opioids and/or stimulants. Fatal overdose observed during follow-up (January 12,015- December 312,018) was retrieved from Vital Statistics Death Registry and BC Coroners Service Data. Potential confounders including age, sex, health region, comorbidities and prescribed medications were retrieved from the provincial client roster and health records. Results We identified 7460 people who used stimulants and or opioids. During follow-up there were 272 fatal overdose events. People who used both opioids and stimulants had more than twice the hazard of fatal overdose (HR: 2.02, 95% CI: 1.47-2.78, p < 0.001) compared to people who used opioids only. The hazard of death increased over time among people who used both opioids and stimulants. Conclusions There is an urgent need to prioritize the service needs of people who use stimulants to reduce overdose mortality in British Columbia. Findings have relevance more broadly in other North American settings, where similar trends in opioid and stimulant polysubstance use have been observed.

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Correlates of concurrent use of stimulants and opioids among people who access harm reduction services in British Columbia, Canada: Findings from the 2019 Harm Reduction Client Survey

Cited by 10 publications

References 27 publications

Predictors and motives of polydrug use in opioid users. A narrative review

Predictors and motives of polydrug use in opioid users. A narrative review

Identifying behaviours for survival and wellness among people who use methamphetamine with opioids in British Columbia: a qualitative study

Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

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