Re-visioning from risk and safety to survival and wellness; behaviours among people who use methamphetamine with opioids in British Columbia, Canada

North America is experiencing an increasingly toxic drug supply. In 2021 the annual illicit drug toxicity deaths in British Columbia (BC), Canada were the highest ever reported. Simultaneously concurrent use of methamphetamine with opioids has increased. The aim of our study was to explore reasons for concurrent use in BC.

Research assistants with lived experience of substance use performed 22 semi-structured interviews with people who used methamphetamine concurrently with opioids. Thematic analysis identified patterns in behaviour; initial themes and subthemes were refined with input from a peer advisory group.

Participants reported adaptations to balance perceived benefits and risk of their substance use. Two overarching themes described how participants adapted their ways of substance use for survival and wellness: 1) Personal safety behaviours e.g. self-regulation and self-care 2) Interpersonal safety behaviour e.g. using with peers, engaging in peer-led and public health–led services. We identified misconceptions about concurrent use, for example some participants believed using methamphetamine with opioids protected them from an opioid overdose; others justified their route of administration based on perceptions of safety. Participants identified trusting relationships with their dealer was a safety behaviour. Some accessed supervised consumption and overdose prevention sites to reduce harms but noted these services were limited especially for those who smoked drugs, and that interventions and supports were lacking for those who used stimulants.

Engagement with a peer advisory group reframed the focus from risk and safety towards survival and wellness. We identified the need to dispel common myths and address gaps in available services to meet the diverse needs of people who use methamphetamine concurrently with opioids.