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Abstract
AimsWe report on motivations for crystal methamphetamine-opioid co-use/co-injection through narratives of people who inject drugs during a period of increased crystal methamphetamine use reporting in Australia.MethodsFourteen in-depth interviews were undertaken with selected participants (12 male, 2 female) from the Melbourne Injecting Drug User Cohort Study, including those in and out of opioid substitution therapy (OST).ResultsThe main motivations for co-use reported by participants were as follows: (1) that heroin could be used to reduce the negative side effects of heavy crystal methamphetamine use, particularly during the ‘comedown’ phase; (2) that small quantities of crystal methamphetamine used with heroin could prolong the intoxication effect of heroin, and hence the time before opioid withdrawal; (3) that co-injection of crystal methamphetamine and heroin produced a more desirable intoxication effect than using either substance on its own and; (4) that crystal methamphetamine provided a substitute ‘high’ for heroin after commencing OST treatment.ConclusionsCo-use of methamphetamine and opioids has been used by people who inject drugs to facilitate intoxication, sometimes as the result of ineffective opioid substitution therapy (OST) treatment and perceived lack of pleasure after stabilisation on OST treatment.
Highlights
Co-use of opioids and stimulants has been a practice widely documented in studies of people who inject drugs (PWID) [1]
Opioids reduce negative side effects of crystal methamphetamine All participants reported that they were engaging in heavy periods of crystal methamphetamine use, with most reporting that this coincided with a rise in crystal methamphetamine availability in their local area
One participant stated that he was unaware of how heavy crystal methamphetamine use was affecting him for several months: nothing would work
Summary
Co-use of opioids and stimulants has been a practice widely documented in studies of people who inject drugs (PWID) [1]. Over the past two decades, Australian methamphetamine markets have been in flux, with parts of the country witnessing the peak of a second methamphetamine ‘epidemic’ in 2014 [9, 10] This was in part sparked by a shift in the predominant form of methamphetamine used (from ‘speed’ to crystal methamphetamine—a typically stronger form) [11] and increased purity of all methamphetamine forms [12] coinciding with increased reporting of crystal methamphetamine-related harms amongst stimulant users and PWID [13]. Motivations for opioid-stimulant co-use have previously been explored in the context of the ‘crack (cocaine) epidemic’ of the late 1980s and early 1990s in the USA These studies suggested that individuals were using a combination of heroin and cocaine to modulate the severity of opiate withdrawal [14,15,16], or to help deal with the over-excitability associated with ‘binge’ cocaine use [14, 17]. These studies suggest that motivations for co-using stimulants and opioids are complex, multifactorial and context dependent, making them difficult to report on
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