The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States
Abstract Background Co-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between su...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-024-00976-1 |
| _version_ | 1797275326317854720 |
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| author | Sarah Mars Jeff Ondocsin Nicole Holm Daniel Ciccarone |
| author_facet | Sarah Mars Jeff Ondocsin Nicole Holm Daniel Ciccarone |
| author_sort | Sarah Mars |
| collection | DOAJ |
| description | Abstract Background Co-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between supply and demand in propelling this polydrug use is not well understood. We consider the influence of macro changes in supply on the uptake of opioid and methamphetamine co-use by injection at the level of individual drug and injection initiation in West Virginia, a state which leads the US in drug overdose mortality. Method We recruited n = 30 people for semi-structured interviews who self-reported injecting heroin/fentanyl and using methamphetamine by any route at a West Virginia syringe service program and through snowball sampling. Interviews were recorded and transcripts analyzed using a thematic approach. Ethnographic observation was also conducted and recorded in fieldnotes. Sequence of substance and mode of use initiation and use trajectories for opioids and stimulants were charted for each participant. Results A clear pattern of individual drug initiation emerged that matched each successive supply wave of the US overdose epidemic: 25 participants had initiated opioid use with pills, followed by heroin, often mixed with/replaced by fentanyl, and subsequently added methamphetamine use. For participants, the supply and consumption of opioid analgesics had set in motion a series of steps leading to the addition of stimulant injection to existing opioid injecting repertoires. Unlike other studies that have found a birth cohort effect in patterns of initiation, participants showed the same sequence across age groups. Considerations of economy, availability, dependence, tolerance and the erosion of taboos that marked transitions from opioid pills to heroin injection influenced these subsequent trajectories in novel ways. The form, timing and extent of opioid and stimulant consumption was influenced by four stages of the changing drug supply, which in turn reflected back on demand. Conclusion Transformations in the social meaning and supply of methamphetamine enabled these transitions while other desired, non-injectable drugs were difficult to obtain. We discuss policy implications of injectable drugs’ market dominance at this location and possible interventions. |
| first_indexed | 2024-03-07T15:11:45Z |
| format | Article |
| id | doaj.art-16d5c43b087d436c9114ad524c2bb800 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-03-07T15:11:45Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-16d5c43b087d436c9114ad524c2bb8002024-03-05T18:06:32ZengBMCHarm Reduction Journal1477-75172024-03-0121111310.1186/s12954-024-00976-1The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United StatesSarah Mars0Jeff Ondocsin1Nicole Holm2Daniel Ciccarone3University of CaliforniaUniversity of CaliforniaUniversity of CaliforniaUniversity of CaliforniaAbstract Background Co-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between supply and demand in propelling this polydrug use is not well understood. We consider the influence of macro changes in supply on the uptake of opioid and methamphetamine co-use by injection at the level of individual drug and injection initiation in West Virginia, a state which leads the US in drug overdose mortality. Method We recruited n = 30 people for semi-structured interviews who self-reported injecting heroin/fentanyl and using methamphetamine by any route at a West Virginia syringe service program and through snowball sampling. Interviews were recorded and transcripts analyzed using a thematic approach. Ethnographic observation was also conducted and recorded in fieldnotes. Sequence of substance and mode of use initiation and use trajectories for opioids and stimulants were charted for each participant. Results A clear pattern of individual drug initiation emerged that matched each successive supply wave of the US overdose epidemic: 25 participants had initiated opioid use with pills, followed by heroin, often mixed with/replaced by fentanyl, and subsequently added methamphetamine use. For participants, the supply and consumption of opioid analgesics had set in motion a series of steps leading to the addition of stimulant injection to existing opioid injecting repertoires. Unlike other studies that have found a birth cohort effect in patterns of initiation, participants showed the same sequence across age groups. Considerations of economy, availability, dependence, tolerance and the erosion of taboos that marked transitions from opioid pills to heroin injection influenced these subsequent trajectories in novel ways. The form, timing and extent of opioid and stimulant consumption was influenced by four stages of the changing drug supply, which in turn reflected back on demand. Conclusion Transformations in the social meaning and supply of methamphetamine enabled these transitions while other desired, non-injectable drugs were difficult to obtain. We discuss policy implications of injectable drugs’ market dominance at this location and possible interventions.https://doi.org/10.1186/s12954-024-00976-1Drug supply, Methamphetamine, Opioids, Injecting drug use, Drug initiation , Drug trajectories |
| spellingShingle | Sarah Mars Jeff Ondocsin Nicole Holm Daniel Ciccarone The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States Harm Reduction Journal Drug supply, Methamphetamine, Opioids, Injecting drug use, Drug initiation , Drug trajectories |
| title | The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States |
| title_full | The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States |
| title_fullStr | The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States |
| title_full_unstemmed | The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States |
| title_short | The influence of transformations in supply on methamphetamine initiation among people injecting opioids in the United States |
| title_sort | influence of transformations in supply on methamphetamine initiation among people injecting opioids in the united states |
| topic | Drug supply, Methamphetamine, Opioids, Injecting drug use, Drug initiation , Drug trajectories |
| url | https://doi.org/10.1186/s12954-024-00976-1 |
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