Understanding concurrent stimulant use among people on methadone: A qualitative study

Area of Science:

• Addiction Medicine
• Public Health
• Qualitative Research

Background:

• Opioid-related overdoses are a major public health crisis in North America.
• Medications for opioid use disorder, like methadone, are increasingly used.
• Some individuals on methadone treatment concurrently use stimulants.

Purpose of the Study:

• To explore the motivations behind concurrent stimulant and methadone use.
• To understand the experiences of a street-involved drug-using population on methadone.
• To inform harm reduction and policy changes.

Main Methods:

• Conducted semi-structured qualitative interviews with 39 individuals on methadone in Vancouver, Canada.
• Recruited participants from ongoing prospective cohort studies of people who use drugs.
• Analyzed interview transcripts using an inductive and iterative approach.

Main Results:

• Stimulants were used to counteract methadone's sedating effects, aiding daily activities and income generation.
• Participants increased stimulant use to compensate for diminished stimulant intoxication while on methadone.
• Some individuals desired stimulant intoxication, as their treatment goals were not abstinence-based.

Conclusions:

• Functional reasons exist for concurrent stimulant and methadone use in populations not pursuing abstinence.
• Nuanced understanding of substance use motivators can inform policy and harm reduction programs.
• Findings support low-threshold, harm reduction-focused methadone treatment and interventions.