Drug use patterns and factors related to the use and discontinuation of medications for opioid use disorder in the age of fentanyl: findings from a mixed-methods study of people who use drugs

Abstract

Background Medications for opioid use disorder (MOUD; methadone, buprenorphine, naltrexone) are the most effective treatments for OUD, and MOUD is protective against fatal overdoses. However, continued illegal drug use can increase the risk of treatment discontinuation. Given the widespread presence of fentanyl in the drug supply, research is needed to understand who is at greatest risk for concurrent MOUD and drug use and the contexts shaping use and treatment discontinuation. Methods From 2017 to 2020, Massachusetts residents with past-30-day illegal drug use completed surveys (N = 284) and interviews (N = 99) about MOUD and drug use. An age-adjusted multinomial logistic regression model tested associations between past-30-day drug use and MOUD use (current/past/never). Among those on methadone or buprenorphine (N = 108), multivariable logistic regression models examined the association between socio-demographics, MOUD type; and past-30-day use of heroin/fentanyl; crack; benzodiazepines; and pain medications. Qualitative interviews explored drivers of concurrent drug and MOUD use. Results Most (79.9%) participants had used MOUD (38.7% currently; 41.2% past), and past 30-day drug use was high: 74.4% heroin/fentanyl; 51.4% crack cocaine; 31.3% benzodiazepines, and 18% pain medications. In exploring drug use by MOUD history, multinomial regression analyses found that crack use was positively associated with past and current MOUD use (outcome referent: never used MOUD); whereas benzodiazepine use was not associated with past MOUD use but was positively associated with current use. Conversely, pain medication use was associated with reduced odds of past and current MOUD use. Among those on methadone or buprenorphine, separate multivariable logistic regression models found that benzodiazepine and methadone use were positively associated with heroin/fentanyl use; living in a medium-sized city and sex work were positively associated with crack use; heroin/fentanyl use was positively associated with benzodiazepine use; and witnessing an overdose was inversely associated with pain medication use. Many participants qualitatively reported reducing illegal opioid use while on MOUD, yet inadequate dosage, trauma, psychological cravings, and environmental triggers drove their continued drug use, which increased their risk of treatment discontinuation and overdose. Conclusions Findings highlight variations in continued drug use by MOUD use history, reasons for concurrent use, and implications for MOUD treatment delivery and continuity.

Trends and correlates of abscess history among people who inject drugs in Massachusetts: A mixed methods exploration of experiences amidst a rapidly evolving drug supply

“…Although prior research from this and other studies ( Ciccarone 2021 ; Hughto et al., 2023 ; Jones et al., 2020 ) have linked fentanyl to an uptick in stimulant use, and methamphetamine and crack use was quantitatively linked to abscess experiences in the present analysis, participants did not explicitly draw a connection between stimulant use and abscesses in interviews. However, due to fentanyl's short half-life, PWID may need to inject more frequently to avoid withdrawal symptoms, therefore introducing more opportunities for skin infections ( Jones et al., 2020 ; Sanchez et al., 2021 ).…”

“…Informed by statewide overdose trends (“SUDORS Dashboard: Fatal Overdose Data” 2022 ), the present analysis focuses on data collected from 2019 to 2022 in nine high-overdose-risk communities: Boston, Chicopee, Cape Cod, Lawrence, Lowell, New Bedford, North Shore (Beverly, Lynn, Peabody, Salem), Quincy, and Springfield. As described elsewhere ( Hughto et al., 2022 ; 2023 ), we partnered with community organizations (e.g., SSPs, homeless shelters, community clinics) and employed purposive sampling to recruit participants with demographic characteristics roughly proportional to that of overdose decedents in each community according to the statewide data. This approach prioritized the recruitment and enrollment of participants who were diverse in terms of age, race, ethnicity, primary drug of choice, and neighborhood of residence.…”

Xylazine Awareness, Desire, Use and Exposure: Preliminary Findings from the Rhode Island CUTS Drug Checking Cohort

“…The survey contained previously-developed measures 20,21,22 and included: (1) socio-demographics (e.g., age, sex, gender identity, race/ethnicity, primary language, education, employment, housing); (2) medical co-morbidities; (3) overdose; (4) drug treatment; (5) FTS use; (6) drug use and social network characteristics; and (7) xylazine awareness, concerns, and perceived exposure, among other measures.…”

Preventing Overdoses Involving Stimulants: The POINTS Study Protocol

“…Drawing on overdose surveillance data 13 and our prior research with PWUD in Massachusetts and Rhode Island, 19,36,[49][50][51][52] we selected 4 locations where fatal stimulant and opioid-involved overdoses were concentrated from which to recruit PWUS and stakeholders. Locations include Providence, RI; Lawrence, MA; Lynn, MA; and Brockton, MA.…”

“…PWUS: Community-Based Referrals. Drawing on our success recruiting PWUD for rapid mixed methods studies in Massachusetts, 19,[49][50][51][56][57][58][59][60][61][62] the POINTS study uses a modi ed respondent-driven sampling approach to recruit PWUS at the 4 community sites. 57,62 Respondent-driven sampling is a network-based sampling method that starts with a convenience sample of initial participants (herein referred to as "seeds") and uses small incentives (e.g., $5 cash, which is modest enough to not engender coercion) to recruit the networks of the seed participants.…”