Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Open. 2022 May 2;12(5):e060447. doi: 10.1136/bmjopen-2021-060447.
An increase in crystal methamphetamine (methamphetamine) use during the overdose epidemic is being observed in British Columbia (BC), Canada, and across North America. Concurrent use (ie, using uppers and downers one after the other or together) can increase the risk of fatal and non-fatal opioid overdose.
We investigated motivations for concurrent use of uppers and downers, specifically how (eg, in what order) and why people use concurrently, to identify potential interventions to prevent overdose and other harms.
The 2019 Harm Reduction Client Survey was administered across 22 harm reduction supply distribution sites in BC (n=621). This thematic analysis examined 307 responses by people who affirmed concurrent use to classify order and reasons for using uppers and downers concurrently.
Of the 307 people who responded 'yes' to concurrent use, 179 (58.3%) used downers then uppers, 76 (24.8%) used uppers then downers and 184 (59.9%) mixed uppers and downers together. Four main reasons for concurrent use emerged: self-medication, availability and preference, drug effects/properties, and financial and life situation. People who mixed drugs together predominantly wanted to achieve desired drug effects/properties, such as a specific high or balancing stimulating and sedating effects.
The ongoing rise in overdoses in BC is multifactorial, and the recent parallel increases in methamphetamine use and concurrent use with opioids may contribute. Qualitative interviews may further elucidate reasons for concurrent use. Addressing reasons for concurrent use identified in this study through harm reduction strategies and education may affect the rates of overdose morbidity and mortality.
在加拿大不列颠哥伦比亚省（BC）和整个北美地区，人们观察到在阿片类药物过量流行期间，冰毒（甲基苯丙胺）的使用有所增加。同时使用（即在一个接着一个或一起使用兴奋剂和抑制剂）会增加致命和非致命阿片类药物过量的风险。
我们调查了同时使用兴奋剂和抑制剂的动机，特别是人们如何（例如，按什么顺序）以及为什么同时使用，以确定潜在的干预措施来预防过量用药和其他危害。
2019 年减少伤害客户调查在 BC 的 22 个减少伤害供应分发点进行（n=621）。这项主题分析研究了 307 名同时使用肯定回答者的回复，以对使用兴奋剂和抑制剂的顺序和原因进行分类。
在 307 名对同时使用做出“是”回应的人中，179 人（58.3%）先使用抑制剂后使用兴奋剂，76 人（24.8%）先使用兴奋剂后使用抑制剂，184 人（59.9%）将兴奋剂和抑制剂混合在一起使用。同时使用的四个主要原因包括：自我治疗、可用性和偏好、药物作用/特性、财务和生活状况。混合药物的人主要是想达到预期的药物作用/特性，例如特定的兴奋或平衡刺激和镇静作用。
BC 过量用药的持续上升是多因素的，冰毒使用的近期增加以及与阿片类药物的同时使用可能是导致这一现象的原因之一。定性访谈可能会进一步阐明同时使用的原因。通过减少伤害策略和教育来解决本研究中确定的同时使用的原因，可能会影响过量用药发病率和死亡率。
