Perceptions of prospective pharmaceutical stimulant substitution treatments among people who use illicit stimulants in Vancouver, Canada

Aims: This qualitative study aims to explore treatment experiences of people who use illicit stimulants (PWUS) to identify treatment gaps, as well as perceptions of prospective pharmaceutical stimulant substitution treatments (SST; e.g. Dexedrine, methylphenidate).

Methods: In-depth qualitative interviews were conducted with 86 PWUS in Vancouver, Canada. Thematic analysis of interviews focused on perceptions and experiences of available treatment programs for stimulant use, treatment needs, and perceptions of prospective pharmaceutical substitution treatment for stimulant use disorder.

Results: Participants challenged perceptions of stimulant users as treatment resistant, rather, identifying how current treatment approaches do not meet the unique needs of PWUS. Participants described how these current approaches are behavioural, contrasting this with the range of medical treatments available for opioid use disorder. If given the opportunity to access SST, participants emphasized the health and social benefits they could anticipate from a medical model of stimulant treatment, including avoiding the toxic supply of illicit stimulants, reduced engagement in criminalized activities, as well as economic benefits. Perceptions of prospective SST were informed by knowledge of existing opioid substitution and agonist therapies, leading some participants to be unsupportive of SST, citing the loss of agency requisite of participation in opioid-related treatments, and highly regulated operational contexts that do not align with the lived realities of stimulant use (e.g., sporadic usage, binge use).

Conclusion: Given emerging clinical evidence suggesting the effectiveness of pharmaceutical alternatives for illicit stimulants, our findings demonstrate the need for SST pilot programs in real-world settings, and underscore the health and social advantages SST may offer; although drawing on existing opioid treatment models to implement an SST pilot may limit its success. Thus, our findings also highlight the need to centre the lived realities of PWUS in any novel treatments for stimulant use. Disclosure of interest: This study was supported by the Canadian Institutes of Health Research.