Motivations for Polysubstance Use with Methamphetamine and Opioids Among People Who Use Drugs in Seattle, WA: A Qualitative Study

BACKGROUND: The United States has seen a remarkable increase in the use of both methamphetamine and opioids, used concurrently or simultaneously. This trend has been particularly marked in urban centers on the West Coast. The motivation for co-use among people who use drugs in this important region is not yet clear. METHODS: We conducted in-depth semi-structured interviews with people who regularly used both methamphetamine and opioids recruited from a syringe services program in downtown Seattle. In addition, SSP staff participated in a focus group discussion (FGD) to share experiences and perceptions on the rise in co-use. We conducted an interpretive descriptive analysis of the data informed by the social-ecological framework to identify multi-level influences on methamphetamine-opioid co-use. RESULTS: Among 21 interviewees and 6 FGD participants, we identified two overarching themes describing methamphetamine-opioid co-use initiation and maintenance. First, at the interpersonal, community, and societal levels, these drugs were highly prevalent and normalized in social networks, community sources, and the illicit drug market. Second, co-use served multiple functions for individuals to provide pleasure, manage pain, and balance drug effects. Co-use also met the social needs of participants responding to family relationships, as well as community-level employment dynamics. The prevalence and utility of methamphetamine and opioids were uniquely elevated among people experiencing homelessness. CONCLUSION: Methamphetamine-opioid co-use was influenced by complex personal, social, and societal factors. Policy to address the needs of people who co-use through treatment, harm reduction, and other social programs must support individuals, their communities, and the broader structural environment.