What are the reasons for injecting methadone? A qualitative study among people who inject drugs in Barcelona

Background

Oral methadone maintenance treatment is the most common, safe, and effective drug therapy for heroin addiction. Intravenous injection of methadone, however, poses a great physical risk, especially when the methadone syrup is used. This study aims to explore the reasons for injecting methadone among drug users, describe the specific benefits and harms of injecting methadone compared to heroin, and identify the advantages and disadvantages of supervised methadone injection in a harm reduction service from the users’ perspective. 

Methods

A descriptive qualitative study was conducted using semi-structured interviews with a phenomenological approach. Eleven patients from a drug consumption room (DCR) of Barcelona accepted to participate in a semi-structured interview during April 2023. The interview script covered information on basic sociodemographic information, clinical details, and drug use. This study was approved by an ethics committee.

Results

The participants consisted of nine men, aged 26 to 53 years, and two women aged 40 and 26 years. All participants were homeless and, except for one, all were polydrug users. The main motivations for injecting methadone included the pursuit of a euphoric rush or instant buzz, the pleasurable aspect of needle insertion, and the avoidance of gastrointestinal and oral discomfort associated with oral methadone use. The main benefit of injecting methadone was ease of access to this opioid compared with other opioids, coupled with its efficacy in easing withdrawal symptoms. A significant disadvantage was the harm inherent in the act of injection. The advantages of using the DCR were the availability of medical assistance in the event of an overdose, ease of access, and the physical safety provided they offered. Drawbacks were related to the waiting time to access the DCR, the absence of round-the-clock access, neighborhood stigmatization, and the distance users had to travel when acquiring methadone on the illegal market. 

Conclusions

Considering findings, we propose harm reduction measures for injected methadone use, aiming to enhance safety and well-being of users. Recommendations include comprehensive education, socio-educational interventions, provision of adequate injection materials, supervised injections, and extended access. Staff training is essential for a person-centered, stigma-free approach to build trust. Public health professionals should prioritize ongoing research into motivations and risks, policy development, targeted training and research into therapeutic alternatives.