Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations
Abstract Background Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may n...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-023-00364-3 |
| _version_ | 1797863859285917696 |
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| author | R. R. Cook C. Foot O. A. Arah K. Humphreys K. E. Rudolph S. X. Luo J. I. Tsui X. A. Levander P. T. Korthuis |
| author_facet | R. R. Cook C. Foot O. A. Arah K. Humphreys K. E. Rudolph S. X. Luo J. I. Tsui X. A. Levander P. T. Korthuis |
| author_sort | R. R. Cook |
| collection | DOAJ |
| description | Abstract Background Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent “real-world” populations who would benefit from treatment. Methods We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. Results Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30–49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49–0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48–1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51–1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35–1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08–0.69, p = 0.008). Conclusions Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD. |
| first_indexed | 2024-04-09T22:43:34Z |
| format | Article |
| id | doaj.art-334520e1fe114e91abdf59a8081e3938 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-04-09T22:43:34Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-334520e1fe114e91abdf59a8081e39382023-03-22T12:00:11ZengBMCAddiction Science & Clinical Practice1940-06402023-02-0118111410.1186/s13722-023-00364-3Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populationsR. R. Cook0C. Foot1O. A. Arah2K. Humphreys3K. E. Rudolph4S. X. Luo5J. I. Tsui6X. A. Levander7P. T. Korthuis8Section of Addiction Medicine, Department of Medicine, Oregon Health & Science UniversitySection of Addiction Medicine, Department of Medicine, Oregon Health & Science UniversityDepartment of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA)Center for Innovation to Implementation, VA Palo Alto Health Care SystemDepartment of Epidemiology, School of Public Health, Columbia UniversityDivision on Substance Use Disorders, Department of Psychiatry, Columbia UniversityDepartment of Medicine, University of WashingtonSection of Addiction Medicine, Department of Medicine, Oregon Health & Science UniversitySection of Addiction Medicine, Department of Medicine, Oregon Health & Science UniversityAbstract Background Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent “real-world” populations who would benefit from treatment. Methods We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. Results Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30–49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49–0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48–1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51–1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35–1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08–0.69, p = 0.008). Conclusions Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.https://doi.org/10.1186/s13722-023-00364-3StimulantsMethamphetamineCocaineMedications for opioid use disorderBuprenorphineExtended-release naltrexone |
| spellingShingle | R. R. Cook C. Foot O. A. Arah K. Humphreys K. E. Rudolph S. X. Luo J. I. Tsui X. A. Levander P. T. Korthuis Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations Addiction Science & Clinical Practice Stimulants Methamphetamine Cocaine Medications for opioid use disorder Buprenorphine Extended-release naltrexone |
| title | Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations |
| title_full | Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations |
| title_fullStr | Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations |
| title_full_unstemmed | Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations |
| title_short | Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations |
| title_sort | estimating the impact of stimulant use on initiation of buprenorphine and extended release naltrexone in two clinical trials and real world populations |
| topic | Stimulants Methamphetamine Cocaine Medications for opioid use disorder Buprenorphine Extended-release naltrexone |
| url | https://doi.org/10.1186/s13722-023-00364-3 |
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