A systematic review and meta-analysis of medications for stimulant use disorders in patients with co-occurring opioid use disorders

Chan, Brian; Freeman, Michele; Ayers, Chelsea; Korthuis, P. Todd; Paynter, Robin; Kondo, Karli; Kansagara, Devan

doi:10.1016/j.drugalcdep.2020.108193

Cited by 43 publications

(46 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While half of the participants in the study had received a stimulant prescription in the past year, the indication for the prescription was not always clear and may have included methamphetamine use harm reduction, attention deficit and hyperactivity disorder treatment, or other reasons. While there have been many medical trials involving participants with OUD, only one involved participants with comorbid OUD and MUD; the lack of medication trials in this growing population highlights an urgent need for further research [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Care-engaged individuals with polysubstance use in Northeastern US are undertreated for methamphetamine use disorder: a retrospective cohort study

Alba

Mitton³

et al. 2021

Addict Sci Clin Pract

View full text Add to dashboard Cite

Background Stimulant use has increased across the US, with concomitant opioid and methamphetamine use doubling between 2011 and 2017. Shifting patterns of polysubstance use have led to rising psychostimulant-involved deaths. While it is known that individuals who use methamphetamine require greater access to treatment, there is still little known about methamphetamine use and treatment among individuals who are already engaged in outpatient substance use treatment. Objectives To characterize care-engaged individuals who use methamphetamine to guide harm reduction and treatment strategies. Methods Retrospective cohort study of individuals at a large academic medical center in Massachusetts with ≥ 2 positive methamphetamine oral fluid toxicology tests between August 2019 and January 2020. We performed descriptive analysis of sociodemographic, medical, and drug use characteristics and a comparative analysis of injection methamphetamine use versus other routes of use. Results Included were 71 individuals [56 male (80%), 66 non-Hispanic white (94%), median age 36 (IQR 30–42)]. Nearly all had opioid (94%) and stimulant use disorder (92%). Most had (93%) or were (83%) being treated with medications for opioid use disorder, but few received pharmacologic treatment for methamphetamine use disorder (24%). None received contingency management treatment. People who inject methamphetamine (68%) were more likely to have a history of overdose (91% vs. 70%; p = 0.02), have HCV (94% vs. 52%; p < 0.01), use fentanyl (93% vs. 65%; p = 0.02), and engage in sex work (19% vs. 0%; p = 0.03) compared to those who used via other routes. Both groups had prevalent homelessness (88% vs. 73%; p = 0.15), incarceration (81% vs. 64%; p = 0.11), depression (94% vs. 87%; p = 0.34), and bacteremia (27% vs. 22%; p = 0.63). Conclusions Individuals in our study had high prevalence of polysubstance use, particularly concomitant methamphetamine and opioid use. Individuals who were well connected to substance use treatment for their opioid use were still likely to be undertreated for their methamphetamine use disorder and would benefit from greater access to contingency management treatment, harm reduction resources, and resources to address adverse social determinants of health.

show abstract

Section: Discussionmentioning

confidence: 99%

Care-engaged individuals with polysubstance use in Northeastern US are undertreated for methamphetamine use disorder: a retrospective cohort study

Alba

Mitton³

et al. 2021

Addict Sci Clin Pract

View full text Add to dashboard Cite

show abstract

“…Given the above-characterized, emerging 'twin-epidemic' of psycho-stimulants alongside the persistent 'opioid crisis', much of which unfolding in actually combined use and co-occurring harms (e.g., overdose) of the two substance categories among highrisk individuals with use, implies that effective interventions realistically serving and attenuating this problem in combination are even more rare and out-of-reach [76,[136][137][138]. This is the essential finding of a recent systematic review of pharmacotherapeutic treatment for stimulant use disorders in patients with co-occurring opioid use disorders, concluding that these interventions are essentially non-existent [139].…”

Section: Implications For Interventionsmentioning

confidence: 99%

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

Fischer

O’Keefe-Markman

Lee

et al. 2021

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

In the early 2000s, increasing prevalence of psycho-stimulant (e.g., crack/cocaine, methamphetamine) use and related harms, including severe adverse health outcomes, was observed among - mostly marginalized - populations of persons using illicit drugs in North America, underscoring an urgent need for interventions options towards improved prevention and treatment. By about 2010, however, the ‘opioid crisis’, featuring unprecedented use and public health burden, had accelerated into full force in North America, largely muting attention to the psycho-stimulant issue until recently. Recent surveillance data on drug use and related mortality/morbidity from the present decade has documented a marked resurgence of psycho-stimulant use and harms especially in at-risk populations, commonly in direct combination with opioids, across North America, resulting in a ‘twin epidemic’ comprised of opioids and psycho-stimulants We briefly review select epidemiological data indicators for these developments from the United States and Canada; in the latter jurisdiction, related evidence has been less prevalent and systematic but corroborating the same trends. Evidently, the (widely ongoing) focus on the ‘opioid epidemic’ as a ‘mono-type’ drug problem has become an anachronism that requires urgent and appropriate correction. We then briefly consider existing, evidence-based options for – prevention and treatment – interventions targeting psycho-stimulant use and harms, which are substantially more limited and/or less efficacious than those available for problematic opioid use, while presenting major gaps and challenges. The observed resurgence of psycho-stimulants may, indirectly, relate to recent efforts towards curtailing (medical) opioid availability, thereby accelerating demand and supply for both illicit opioids and psycho-stimulants. The presently unfolding ‘twin epidemic’ of opioids and psycho-stimulants, combined with limited intervention resources, presents an acute challenge for public health and may crucially undermine actively extensive efforts to reduce opioid-related health harms in North America.

show abstract

“…Although patients with polysubstance use disorders are more likely to have poorer outcomes, earlier treatment discontinuation, and increased hospitalizations, many studies on the treatment of stimulant use disorder exclude patients with co-occurring OUD. 49 Several SRs 8,9,50 on pharmacotherapy for CUD find SSRIs, TCAs, anticonvulsants, dopamine agonists, n-acetylcysteine, opioid agonist therapy, and disulfiram to have insufficient data to demonstrate benefits on abstinence, cocaine use, or treatment retention. Adverse effects associated with SSRIs may increase the risk of dropout.…”

Section: Case 3: Cud With Co-occurring Oudmentioning

confidence: 99%

“…8,9,50 Bupropion, topiramate, and high-dose psychostimulants (ie, FDA maximum recommended doses or higher) have lowstrength evidence that they may increase continuous abstinence at 2 weeks or more. 8,9,33,50 Chan et al 49 conducted a meta-analysis of 34 RCTs to address the benefit of pharmacotherapy on abstinence, cocaine use, and treatment retention in patients with OUD and CUD. Trials with abstinence defined as cocainenegative in UDS for 3 consecutive weeks were included.…”

Section: Case 3: Cud With Co-occurring Oudmentioning

confidence: 99%

Pharmacotherapy treatment of stimulant use disorder

Liu¹

2021

Mental Health Clinician

View full text Add to dashboard Cite

Stimulant use disorder (SUD) is a public health problem in the United States that is associated with increased morbidity and mortality. Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the main treatment modality for SUDs and no pharmacotherapy is currently FDA approved for this indication. Although some medications show promising data for the treatment of SUD, the evidence remains inconsistent, and the clinical application is limited due to the heterogenicity of the population and the lack of studies in patients with various comorbidities. Selection of pharmacotherapy treatment for methamphetamine intoxication, persistent methamphetamine-associated psychosis with methamphetamine use disorder, and cocaine use disorder in patients with co-occurring OUD are discussed in 3 patient cases.

show abstract

A systematic review and meta-analysis of medications for stimulant use disorders in patients with co-occurring opioid use disorders

Cited by 43 publications

References 48 publications

Care-engaged individuals with polysubstance use in Northeastern US are undertreated for methamphetamine use disorder: a retrospective cohort study

Care-engaged individuals with polysubstance use in Northeastern US are undertreated for methamphetamine use disorder: a retrospective cohort study

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

Pharmacotherapy treatment of stimulant use disorder

Contact Info

Product

Resources

About