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

Abstract

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.

An Inpatient Protocol for the Treatment of Methamphetamine Withdrawal in Patients With and Without Opioid Use Disorder

“…Of note is that similar to the literature, 17 the majority of the patients had other SUDs such as opioid use disorder in addition to METH (87%). In fact, only a minority of cases had only METH use as a presenting disorder making it difficult to assess the impact of the protocol on METH alone.…”

“…Given recent increases in rates of METH use among people who also use opioids, 3,18 the present sample is generalizable to other acute inpatient settings in which patients with comorbid SUD including METH use present. Recent research characterizing people who use meth METH in the same geographical region found similarly high rates of OUD (94%) as well as single relationship status (75%) and homelessness (85%) 17 . Thus, while the current sample size was small, the METH protocol was implemented with a population characteristically similar to the greater region in terms of polysubstance use and sociodemographic.…”

“…Recent research characterizing people who use meth METH in the same geographical region found similarly high rates of OUD (94%) as well as single relationship status (75%) and homelessness (85%). 17 Thus, while the current sample size was small, the METH protocol was implemented with a population characteristically similar to the greater region in terms of polysubstance use and sociodemographic. Furthermore, this comorbidity supports the potential effectiveness of the protocol for improving patient retention, as polysubstance use is associated with increased rates of premature treatment discontinuation.…”

Polysubstance use and lived experience: new insights into what is needed

“…Research is catching up, as the number of academic papers on polysubstance use has increased in recent years, from 60 published in 2012 to 289 published in 2022. As compared to use of a single substance, polysubstance use is associated with a higher risk of overdose, undertreatment and poor treatment outcomes such as relapse [1][2][3]. The literature explicitly at the intersection of lived experience and polysubstance use is sparse, but the links between these concepts are clear.…”

Exploring Gender and Ethnoracial Differences and Trends in Methamphetamine Treatment

“…The Southwest region has historically reported high rates of methamphetamine use, yet use is increasing in the Northeast and certain parts of the Midwest. 1 , 4 , 5 , 9 , 10 , 12 - 14 Young adults, 6 , 15 men, 3 , 4 , 16 - 18 and those of low socioeconomic status 1 , 14 , 18 , 19 have historically been associated with higher rates of methamphetamine use. Although these rates have been increasing, trend comparison using national surveys (eg, National Survey on Drug Use and Health—NSDUH) is inconclusive due to changes in the methodology.…”