Self‐managing illicit stimulant use: A qualitative study with patients receiving injectable opioid agonist treatment

Abstract

Introduction and Aims. Illicit stimulant use is prevalent among patients receiving injectable opioid agonist treatment (iOAT) and has been associated with early treatment discontinuation and illicit opioid use. Despite these concerns, little is known about the use of illicit stimulants in this population. As such, this study aimed to explore the processes by which patients receiving iOAT engage in the use of illicit stimulants. Design and Methods. One-on-one in-depth qualitative interviews were conducted. Data collection and analysis followed an iterative approach of coding, searching for meaning, and returning to data collection to saturate categories and explicate relationships between them. Participants were patients receiving iOAT in Vancouver, Canada that reported the use of illicit stimulants (n = 31). Results. The process of 'self-managing illicit stimulant use' was constructed from the data. This process was made up of three interrelated categories reflecting participants' engagement in illicit stimulant use: (i) distancing from the street environment; (ii) taking control of use; and (iii) mobilising support (clinical and social). Discussion and Conclusions. For patients with opioid use disorder and concurrent stimulant use disorder, access to iOAT can promote the self-management of illicit stimulant use. Daily visits to the clinic for opioid agonist treatment present an important opportunity to offer services and supports for patients who use illicit stimulants. Interventions can be guided by patients, recognising them as experts in the management of their stimulant use.

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment

“…Fourth, while many clinical trials have investigated the effectiveness of this medication separately among people with cocaine or methamphetamine use disorder, participants in the present study reported cocaine and/or methamphetamine use. Nevertheless, a prior qualitative study investigating patients’ illicit stimulant use in this study setting (iOAT clinic) found no differences across themes by reported illicit stimulant use type [ 17 ]. Furthermore, the present study includes only participants who remained engaged with the iOAT clinic and thus the perspective of people who received dextroamphetamine but were not well engaged in iOAT are not represented.…”

“…Analysis began with an inductive, data-driven approach, whereby codes were attached to the data to directly reflect participants’ words, rather than applying a pre-existing coding framework. Coding was conducted by author HP who has extensive experience collecting and analyzing qualitative research data with patients in the iOAT setting [ 17 – 19 ]. Data collection began with broad questioning about the benefits and challenges of the medication, and subsequent data collection included more specific and focused questioning on sub-topics identified as important in initial data collection.…”

Methadone Maintenance Treatment Discontinuation Among Young People who use Opioids in Vancouver, Canada

“…To date, preliminary research has found that when adequately dosed, the provision of stimulants alongside MOUD reduces both illicit opioid and stimulant use. [54][55][56][57] Given the potential benefits of prescribing both prescription opioids and stimulants to AYA, future research investigating the use of both types of medications and their impact on the health of AYA may be beneficial.…”

Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with injectable opioid agonist treatment patients

“…Analysis began with an inductive, data-driven approach, whereby codes were attached to the data to directly re ect participants' words, rather than applying a pre-existing coding framework. Coding was conducted by author HP who has extensive experience collecting and analyzing qualitative research data with patients in the iOAT setting [17][18][19]. Data collection and analysis were iterative, where initial codes generated from analysis of the focus group data offered insights into important areas of further inquiry for subsequent interviews.…”