Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk
Background Attention-deficit and hyperactivity disorder (ADHD) is frequently diagnosed in patients with substance use disorders (SUDs), including opioids. There remains concern about the safety and efficacy of prescription amphetamines (PAs) and their impact on effectiveness of opioid use disorder (...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | BMJ Mental Health |
| Online Access: | https://ebmh.bmj.com/content/26/1/e300728.full |
| _version_ | 1797367922427953152 |
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| author | Frances R Levin Richard A Grucza Vitor Tardelli Kevin Y Xu Adam Bisaga Thiago M Fidalgo |
| author_facet | Frances R Levin Richard A Grucza Vitor Tardelli Kevin Y Xu Adam Bisaga Thiago M Fidalgo |
| author_sort | Frances R Levin |
| collection | DOAJ |
| description | Background Attention-deficit and hyperactivity disorder (ADHD) is frequently diagnosed in patients with substance use disorders (SUDs), including opioids. There remains concern about the safety and efficacy of prescription amphetamines (PAs) and their impact on effectiveness of opioid use disorder (OUD) treatment with buprenorphine.Objectives To assess the effect of PAs on OUD buprenorphine treatment retention and/or SUD-related emergency admission or drug-related poisonings.Methods We used a retrospective cohort design with a secondary analysis of data from Merative MarketScan Commercial and Multi-State Medicaid Databases from 1 January 2006 to 31 December 2016. Individuals included were aged 12–64 years, had an OUD diagnosis and were prescribed buprenorphine. Our analysis used multivariable Cox regression to evaluate the relationship between PA receipt and time to buprenorphine discontinuation. The second part focused on subsamples of buprenorphine initiators who had either (1) any SUD-related emergency admissions or (2) drug-related poisoning. These outcomes were modelled as a function of PA exposure using conditional logistic regression models as part of a within-person, case-crossover design.Findings Our sample had 90 269 patients with OUD (mean age 34.2 years (SD=11.3)) who initiated buprenorphine. Being prescribed a PA was associated with improved buprenorphine retention among individuals both with (adjusted HR (aHR) 0.91 (95% CI 0.86 to 0.97)) and without a concurrent psychostimulant use disorder (PSUD) (aHR 0.92 (95% CI 0.90 to 0.93)).Conclusions PA use was associated with improved buprenorphine retention in people with OUD with and without co-occurring PSUD. The risks of acute SUD-related events and drug-related poisonings associated with PA use did not differ when comparing PA-using days with days without PA use.Clinical implications Patients with OUD on buprenorphine should receive treatment with a PA when indicated. |
| first_indexed | 2024-03-08T17:24:05Z |
| format | Article |
| id | doaj.art-d7eac33b01f5488e9591938451ae39bf |
| institution | Directory Open Access Journal |
| issn | 2755-9734 |
| language | English |
| last_indexed | 2024-03-08T17:24:05Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj.art-d7eac33b01f5488e9591938451ae39bf2024-01-03T01:05:11ZengBMJ Publishing GroupBMJ Mental Health2755-97342023-10-0126110.1136/bmjment-2023-300728Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose riskFrances R Levin0Richard A Grucza1Vitor Tardelli2Kevin Y Xu3Adam Bisaga4Thiago M Fidalgo54 Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York City, New York, USA6 Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA1 Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil3 Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA4 Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York City, New York, USA1 Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, BrazilBackground Attention-deficit and hyperactivity disorder (ADHD) is frequently diagnosed in patients with substance use disorders (SUDs), including opioids. There remains concern about the safety and efficacy of prescription amphetamines (PAs) and their impact on effectiveness of opioid use disorder (OUD) treatment with buprenorphine.Objectives To assess the effect of PAs on OUD buprenorphine treatment retention and/or SUD-related emergency admission or drug-related poisonings.Methods We used a retrospective cohort design with a secondary analysis of data from Merative MarketScan Commercial and Multi-State Medicaid Databases from 1 January 2006 to 31 December 2016. Individuals included were aged 12–64 years, had an OUD diagnosis and were prescribed buprenorphine. Our analysis used multivariable Cox regression to evaluate the relationship between PA receipt and time to buprenorphine discontinuation. The second part focused on subsamples of buprenorphine initiators who had either (1) any SUD-related emergency admissions or (2) drug-related poisoning. These outcomes were modelled as a function of PA exposure using conditional logistic regression models as part of a within-person, case-crossover design.Findings Our sample had 90 269 patients with OUD (mean age 34.2 years (SD=11.3)) who initiated buprenorphine. Being prescribed a PA was associated with improved buprenorphine retention among individuals both with (adjusted HR (aHR) 0.91 (95% CI 0.86 to 0.97)) and without a concurrent psychostimulant use disorder (PSUD) (aHR 0.92 (95% CI 0.90 to 0.93)).Conclusions PA use was associated with improved buprenorphine retention in people with OUD with and without co-occurring PSUD. The risks of acute SUD-related events and drug-related poisonings associated with PA use did not differ when comparing PA-using days with days without PA use.Clinical implications Patients with OUD on buprenorphine should receive treatment with a PA when indicated.https://ebmh.bmj.com/content/26/1/e300728.full |
| spellingShingle | Frances R Levin Richard A Grucza Vitor Tardelli Kevin Y Xu Adam Bisaga Thiago M Fidalgo Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk BMJ Mental Health |
| title | Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk |
| title_full | Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk |
| title_fullStr | Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk |
| title_full_unstemmed | Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk |
| title_short | Prescription amphetamines in people with opioid use disorder and co-occurring psychostimulant use disorder initiating buprenorphine: an analysis of treatment retention and overdose risk |
| title_sort | prescription amphetamines in people with opioid use disorder and co occurring psychostimulant use disorder initiating buprenorphine an analysis of treatment retention and overdose risk |
| url | https://ebmh.bmj.com/content/26/1/e300728.full |
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