What question did this study set out to answer?

This study aims to explore the experiences and perspectives of patients on methadone who also use cocaine during treatment.

July 6, 2026

Drug Use, Treatment, and Hopes for the Future: A Qualitative Study of Patients on Methadone Who Use Cocaine in the Age of Fentanyl

Key Points

This study aims to explore the experiences and perspectives of patients on methadone who also use cocaine during treatment.
Qualitative interviews conducted with 21 participants after randomization into a clinical trial.
Participants were purposively sampled from the intervention arm of a multi-site trial on a digital behavioral intervention.
Analysis focused on identifying themes related to drug use and treatment experiences.
Participants identified cocaine use stemming from emotional and physical challenges.
Three key themes emerged: coping factors for use, cycles of treatment commitment, and active engagement efforts.
Emphasized hope for temporary methadone treatment and the importance of individualized care for improved outcomes.

Abstract

Background: Ongoing cocaine use is common during methadone treatment and is associated with poorer outcomes. Digital health tools offer promising new ways to enhance methadone treatment through remote delivery of adjunctive behavioral health interventions. The experiences of patients on methadone who also use cocaine are under-represented in the recent literature. This qualitative study of recently admitted patients on methadone who also used cocaine examines their experiences and views on drug use and treatment. Methods: Twenty-one participants were purposively sampled from the intervention arm of an ongoing multi-site clinical trial of a digital behavioral intervention. Qualitative interviews were carried out approximately 3 months after randomization into the parent study. Results: Three themes emerged from the analysis: (1) Cocaine Use as a Response to Physical and Emotional Factors; (2) Cycles of Use and Recommitment to Treatment; and (3) Active Efforts to Sustain Engagement in Treatment. Participants were able to identify and share reasons for entering treatment and their persistent cocaine use. Many participants emphasized a hope that methadone treatment would be temporary. Several participants highlighted the role of internal factors (eg, stress, shame, and desire for stability) related to treatment engagement, and the role of adjunctive behavioral supports in targeting internal factors. Conclusions: Individuals with opioid and cocaine use enter methadone treatment for different reasons, often with co-occurring substance use disorders. Aligning care with their individual goals can potentially improve outcomes. Grounding treatment strategies in individuals’ lived experiences can deepen understanding of how adjunctive digital behavioral interventions can best support engagement, retention, and recovery during the critical early phases of treatment, especially as the illicit drug supply becomes more complex.

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