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 (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.

Informations de copyright

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: AB received grants from National Institutes of Health (NIH), research support and medication samples from Alkermes, and consulting fees from OpheliaHealth, a telehealth provider for opioid use disorder. FRL reported consulting for Major League Baseball, receiving grants from the National Institutes of Health (NIH) and Substance Abuse and Mental Health Services Administration (SAMHSA), receiving a salary from the New York State Psychiatric Institute, and receiving non-financial support from US World Meds, Alkermes and Indivior outside the submitted work and serving as an uncompensated member of scientific advisory boards of Alkermes, Indivior, Novartis International, Teva Pharmaceutical Industries and US WorldMeds. RAG reported receiving grants from the NIH and Arnold Ventures during the conduct of the study, consulting for Janssen Pharmaceuticals and receiving personal fees for grant reviews from the NIH outside the submitted work.