Citation

Tsui JI. JAMA Netw. Open 2022; 5(5): e2211641.

Copyright

(Copyright © 2022, American Medical Association)

DOI

10.1001/jamanetworkopen.2022.11641

PMID

35544141

Abstract

In the US, there is currently a major push to expand access to medications for opioid use disorder (OUD) treatment such as buprenorphine in response to the overdose epidemic. Efforts to improve health outcomes by increasing access to OUD treatment are being challenged by the recent rise in co-use of stimulants, driven primarily by methamphetamine use. The emergence of this "twin epidemic"1 has major implications for OUD treatment: concurrent methamphetamine use has been shown to be associated with persistent opioid use and nonretention.2 There are currently no US Food and Drug Administration-approved medications to treat stimulant use disorders. However, 1 systematic review and meta-analysis3 found low-quality evidence that stimulant medication for treatment of attention-deficit hyperactivity disorder (ADHD) may be of some benefit for methamphetamine and amphetamine use disorders. Furthermore, the literature shows ADHD to be more prevalent among persons with substance use disorders compared with the general population; thus, a substantial proportion (as much as one-quarter) of individuals with OUD may have an underlying diagnostic indication for these medications.4 Buprenorphine prescribers are not uncommonly faced with requests to prescribe stimulant medications for their patients, and to date there has been a lack of evidence on risks and benefits to guide clinical decision-making. A recent study in JAMA Network Open by Mintz et al5 addresses this important gap in the literature.

In their study, Mintz et al5 performed secondary analyses of administrative claims data from commercial and Medicaid databases from January 1, 2006, to December 31, 2016, evaluating whether stimulant medications for ADHD were associated with drug-related poisonings (ie, overdose) and examining treatment retention among individuals aged 12 to 64 years prescribed buprenorphine who had already experienced at least 1 drug-related poisoning. The prerequisite of a prior drug-poisoning event was necessitated by the within-person repeated-event case-crossover cohort study design that required the sample to experience the outcome of interest. The analyses included 13 778 567 person-days of observation time among 22 946 individuals who experienced a drug-related poisoning, of whom nearly half (49.7%) were women and the mean (SD) age was 32.8 (11.8) years. The mere size of this sample and the relatively young age bear witness to the magnitude of the overdose crisis. ...

Language: en