Crack cocaine use among aging Mexican American men with heroin use histories: motivations and polydrug use patterns

Background Knowledge about the motivations for crack cocaine use and the long-term effects among people who inject heroin is limited. This study aims to understand motivations associated with this co-use drug pattern among aging men entrenched in established intergenerational heroin subcultures. Methods: A sample of 60 men with diverse injecting heroin use histories was recruited from low-income Mexican American urban communities for semi-structured ethnographic interviews using respondent-driven sampling. Qualitative analysis was then employed to provide an in-depth understanding of patterns and motivations of polydrug use among this older population. Results: The men discussed motivations including tolerance, curiosity and experimentation, a paradox of affordability, alternatives to the health hassles and stigma, and the cross-fertilization of drug markets. Concurrent and switching use patterns were primarily reported among those seeking a new or different high, while replacement patterns were reported by men in methadone treatment or by those who had tired of injection. Discussion: Findings translate to the on-going opioid crisis and the emerging trend in polysubstance use involving crack cocaine, methamphetamine and other psychostimulants among people who use heroin. More research is needed to investigate the full range of social and health consequences associated with these co-use patterns. Targeted and tailored prevention and treatment services are essential to improve outcomes among aging Mexican American men who use heroin and other persons with similar polydrug use patterns.