Predictors of crystal methamphetamine use initiation or re-initiation among people receiving opioid agonist therapy: A prospective cohort study

In the context of the ongoing opioid crisis in the United States and Canada, opioid agonist therapy (OAT) is the first-line treatment for opioid use disorder. However, there is growing concern regarding the increasing methamphetamine use among those on OAT, as well as the impact of such use may have on OAT retention and outcomes. We sought to identify the predictors of crystal methamphetamine initiation or re-initiation among people on OAT, in order to facilitate the development of effective preventive strategies.

We employed multivariable generalized estimating equations to identify the predictors of crystal methamphetamine use initiation or re-initiation among those who were on OAT within two prospective cohorts in Vancouver, Canada between 2005 and 2020.

Of the 1281 participants receiving OAT, the median age was 43 years, and 59.2 % were male at baseline. During study follow-up, 564 (44.0 %) initiated or re-initiated crystal methamphetamine use while receiving OAT. In a multivariable model, a higher crystal methamphetamine use initiation or re-initiation rate was positively associated with younger age, unstable housing, unprotected sex, history of crystal methamphetamine use, as well as recent cocaine, prescription opioid, and unregulated opioid use (all p < 0.05).

We identified high and increasing rates of crystal methamphetamine use initiation or re-initiation among our sample of people on OAT. Intervention strategies including housing program referral, sexual risk reduction, and integrated treatment approaches targeting polysubstance use are urgently needed to reduce the risks associated with methamphetamine use as well as the co-use of methamphetamine and opioids.