Biological Sciences Division
Published April 1, 2024 | Version v1
Journal article Open

Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: A multi-site qualitative inquiry

Creators

  • 1. University of Washington
  • 2. Oregon Health & Science University
  • 3. University of North Carolina at Chapel Hill
  • 4. The Ohio State University
  • 5. New York University
  • 6. Southern Illinois University
  • 7. Comagine Health
  • 8. University of North Carolina at Chapel Hil
  • 9. Tufts University
  • 10. University of Chicago
  • 11. West Virginia University
  • 12. Cornell University
  • 13. Tulane University
  • 14. Emory University

Description

Background: In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings.

Methods: We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use.

Results: We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment.

Conclusion: In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.

Data availability

We welcome collaboration and encourage mentorship and the use of the ROI data stripped of all protected health information (PHI) to enable early investigators to address meaningful questions with support to help ensure their success. Additional information can be obtained at the ROI website: ruralopioidinitiative.org or by contacting the ROI DCC. Follow the Rural Opioid Initiative on Twitter @ruralopioids.

Files

Motivation-and-context-of-concurrent-stimulant-and-opioid-use-among-persons-who-use-drugs-in-the-rural-United-States.pdf

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Additional details

Identifiers

DOI
10.1186/s12954-024-00986-z
Other
oai:uchicago.tind.io:11473

Funding

NIDA
U24DA048538 from NIDA
NIDA, ARC, CDC, and SAMHSA
UG3DA044829/UH3DA044829
NIDA, ARC, CDC, and SAMHSA
UG3DA044798/UH3DA044798
NIDA, ARC, CDC, and SAMHSA
UG3DA044830/UH3DA044830
NIDA, ARC, CDC, and SAMHSA
UG3DA044823/UH3DA044823
NIDA, ARC, CDC, and SAMHSA
UH3DA044822/UH3DA044822
NIDA, ARC, CDC, and SAMHSA
UG3DA044831/UH3DA044831
NIDA, ARC, CDC, and SAMHSA
UG3DA044825
NIDA, ARC, CDC, and SAMHSA
UG3DA044826/UH3DA044826
NIDA, ARC, CDC, and SAMHSA
U24DA044801
Agency for Healthcare Research and Quality
K12HS026370

UChicago Information

Division(s)
Biological Sciences Division
Department(s)
Medicine