Co-use of methamphetamine and opioids among people in treatment in Oregon: A qualitative examination of interrelated structural, community, and individual-level factors

• Published in: The International journal of drug policy 2021-05, Vol.91, p.103098-103098, Article 103098
• Main Authors: Lopez, Andrea M., Dhatt, Zena, Howe, Mary, Al-Nassir, Marwa, Billing, Amy, Artigiani, Eleanor, Wish, Eric D.
• Format: Article
• Language: English
• Subjects: Amphetamines; Analgesics, Opioid - therapeutic use; Averages; Community; Complementarity; Data collection; Decision making; Diagnostic tests; Drug abuse; Drug Overdose - drug therapy; Drug Overdose - epidemiology; Drug policy; Drug use; Emergency communications systems; Ethnography; Harm reduction; Heroin; Humans; Individual differences; Medical treatment; Methamphetamine; Narcotics; Opioid-Related Disorders - drug therapy; Opioids; Oregon; Patients; Policy making; Qualitative; Qualitative research; Sampling; Social sciences; Stigma; Substance abuse treatment; Time; Treatment programs; United States; Urinalysis
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2020.103098

•Rapid ethnographic assessment and social science/anthropological framework provides methodological complementarity to deepen and contextualize urinalysis findings.•The interrelationship between structural, community, and individual-level factors is key to understanding methamphetamine and opioid co-use.•Co-users of methamphetamine and opioid experience compounded stigma.•Drug use dynamics impacted by local community context and history.•The expertise of PWUD who enact harm reduction strategies in dynamic local contexts are key to mitigating harms associated with co-use. Rates of methamphetamine use and methamphetamine-related deaths have increased steadily in the United States in recent years. Methamphetamine is increasingly present in opioid-related deaths. An initial study of de-identified urine specimens (n = 102) collected at a drug treatment program between 2017 and 2018 indicated that 61% of specimens contained methamphetamine; of the specimens containing methamphetamine, people were, on average, five years younger than those who tested negative for methamphetamine; and non-fentanyl opioids were more than three times as common in methamphetamine positive specimens. The National Drug Early Warning System (NDEWS) Coordinating Center initiated a HotSpot Study to assess whether there was an emerging dynamic in the area, or if enhanced data collection could give insights into the co-use of methamphetamine and opioids. A qualitative study, grounded in principles of rapid ethnographic assessment and a social science/anthropological framework was conducted and used methodological complementarity to contextualize results from the initial urinalysis study. Targeted sampling was conducted at two treatment sites. Program staff and patients were recruited to participate in focus groups and semi-structured interviews to assess structural, community, and individual-level factors impacting methamphetamine and opioid co-use. Within our broader framework of structural, community, and individual-level factors intersecting co-use, our data yielded three sub-themes: 1) the circulation of stigma regarding methamphetamine use was consistently described by both patients and staff and this intersected structural changes in treatment policy and suggested compounded stigma; 2) community-level factors and temporality were important for understanding patterns of methamphetamine use and for further interpreting the initial urinalysis; 3) patient rationales regarding the co-use o