Abstract
BackgroundHeroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam.MethodsWe conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants’ experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach.ResultsOf 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV.ConclusionsParticipant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally.Trial registrationBRAVO - NCT01936857, September 2013.
Highlights
Heroin use continues to drive Human Immunodeficiency Virus (HIV) transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread
Any history of prior or current methamphetamine use was reported by 68% of participants either on a written questionnaire or in response to interview questions, while any history of prior or current alcohol use was reported by 75% of participants (Table 1)
Five major themes emerged regarding use of methamphetamine and alcohol among study participants: Theme 1: methamphetamine and alcohol were perceived to have lower addiction potential than heroin Most participants with a history of methamphetamine or alcohol use did not perceive themselves to be addicted to either substance, which they explicitly contrasted with heroin
Summary
Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. An estimated 57.8 million people worldwide use opioids, of whom 30.4 million use opiates such as heroin [1]. These estimates, based on recent epidemiologic studies, indicate that the global prevalence of opioid use disorder (OUD) is significantly higher than was previously thought. Alcohol is the most common secondary substance used among people who use drugs in Europe; in the United States 35% of people who use heroin meet criteria for alcohol use disorder [5, 7]. Alcohol use is prevalent among patients receiving treatment for OUD: an estimated one-third of patients receiving medication for opioid use disorder (MOUD) have an alcohol use disorder [8, 9]
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