Identifying behaviours for survival and wellness among people who use methamphetamine with opioids in British Columbia: A qualitative study

Abstract Background: British Columbia has been in a state of public health emergency since 2016, due to the unprecedented numbers of overdoses and overdose deaths. Methamphetamine (MA) detection in illicit drug toxicity deaths increased from 14% in 2012 to 43% in 2020 suggesting a concerning trend of concurrent MA and opioid use in BC that reflects rising patterns identified across North America. People who use MA concurrently with opioids face an elevated risk of harm. This study aimed to identify behaviours of people who concurrently use MA and opioids practice to be safe.Methods: One-on-one semi-structured interviews were conducted by Peer Research Assistants in person and by telephone. Each interview lasted approximately 30-90 minutes and were recorded and later transcribed. Thematic analysis was carried out to identify patterns in the behaviours participants described as important to their safety in the context of concurrently using MA and opioidsResults: Participants (n=22) were distributed across the province with at least four participants from each of the five geographic health regions; 64% self-identified as men, and 50% self-identified as Indigenous. Daily MA use was reported by 72.7% of participants, and 67.3% reported using alone either often or always. From the data, we identified that participants made several considerations and adaptations in order to balance the perceived benefits and risks of their use of MA with opioids. Two overarching themes were identified to describe how participants adapted their use for survival and wellness: 1) Personal safety behaviours, and 2) interpersonal safety behaviours.Conclusions: This manuscript identified diversity in participants’ MA and opioid use (i.e. frequency, route of administration), and a subsequent range of behaviours that were performed to improve wellness and survival while using MA and opioids. Some of participants’ behaviours were practiced individually, while others relied peer support, or public health service provision. Participants identified many gaps in available services to meet their diverse needs. Harm reduction and treatment responses must be robust and adaptable to respond to the diversity of patterns of substance use among people who use opioids and MA concurrently, so as to not perpetuate harm and leave people behind.