BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
Faculty of Health Sciences, SFU, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Harm Reduct J. 2022 May 19;19(1):46. doi: 10.1186/s12954-022-00630-8.
British Columbia (BC) has been in a state of public health emergency since 2016, due to the unprecedented numbers of fatal and non-fatal drug toxicity (i.e. overdose) events. Methamphetamine detection in illicit drug toxicity deaths increased from 14% in 2012 to 43% in 2020 suggesting a concerning trend of concurrent methamphetamine and opioid use in BC, consistent with rising patterns identified across North America. People who use methamphetamine concurrently with opioids face an elevated risk of harm. This study aimed to identify behaviours for survival and wellness practiced by people who concurrently use methamphetamine and opioids.
One-on-one semi-structured interviews were conducted by peer research assistants in person and by telephone. Thematic analysis was carried out to identify patterns in behaviours participants described as important to their safety in the context of concurrent use of methamphetamine and opioids.
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 methamphetamine use was reported by 72.7% of participants, and 67.3% reported using alone either often or always. Participants made several considerations and adaptations in order to balance the perceived benefits and risks of their use of methamphetamine with opioids. Two overarching themes were identified to describe how participants adapted their use for survival and wellness. The first was personal safety behaviours which included self-regulation and self-care behaviours. The second was interpersonal safety behaviours which included using alongside peers, and engaging with peer-led services (e.g. community outreach organizations) and public health-led services (e.g. overdose prevention sites) to reduce the risk of harm. Participants identified many gaps in available services to meet their diverse needs.
This manuscript identified diversity in participants' methamphetamine and opioid use (i.e. frequency, route of administration), and a range of behaviours that were performed to improve wellness and survival while using methamphetamine and opioids. Harm reduction and treatment responses must be robust and adaptable to respond to the diversity of patterns of substance use among people who use methamphetamine and opioids concurrently, so as to not perpetuate harm and leave people behind.
自 2016 年以来，不列颠哥伦比亚省（BC）一直处于公共卫生紧急状态，原因是致命和非致命药物毒性（即过量）事件数量空前。在非法药物毒性死亡中，检测到的冰毒增加，从 2012 年的 14%增加到 2020 年的 43%，表明 BC 中冰毒和阿片类药物同时使用的情况令人担忧，与在整个北美发现的上升模式一致。同时使用冰毒和阿片类药物的人面临更高的伤害风险。本研究旨在确定同时使用冰毒和阿片类药物的人所采取的生存和健康行为。
通过同伴研究助理亲自和通过电话进行一对一的半结构式访谈。对参与者描述的与同时使用冰毒和阿片类药物有关的重要行为进行主题分析，以确定模式。
参与者（n=22）分布在全省各地，每个地理卫生区域至少有四名参与者：64%的人自我认同为男性，50%的人自我认同为土著人。72.7%的参与者报告每天使用冰毒，67.3%的人报告经常或总是独自使用。为了平衡他们使用冰毒和阿片类药物的好处和风险，参与者进行了多次考虑和调整。确定了两个总体主题来描述参与者如何调整他们的使用以维持生存和健康。第一个是个人安全行为，包括自我调节和自我护理行为。第二个是人际安全行为，包括与同伴一起使用，并参与同伴领导的服务（例如社区外展组织）和公共卫生领导的服务（例如过量预防场所），以降低伤害风险。参与者确定了现有服务存在许多差距，无法满足他们的多样化需求。
本文确定了参与者冰毒和阿片类药物使用（即频率、给药途径）的多样性，以及为了改善使用冰毒和阿片类药物时的健康和生存而采取的一系列行为。减少伤害和治疗反应必须强大且具有适应性，以应对同时使用冰毒和阿片类药物的人使用模式的多样性，以免造成伤害并使人们掉队。
