The impact of methamphetamine/amphetamine use on receipt and outcomes of medications for opioid use disorder: a systematic review

Abstract

Background Methamphetamine/amphetamine use has sharply increased among people with opioid use disorder (OUD). It is therefore important to understand whether and how use of these substances may impact receipt of, and outcomes associated with, medications for OUD (MOUD). This systematic review identified studies that examined associations between methamphetamine/amphetamine use or use disorder and 3 classes of outcomes: (1) receipt of MOUD, (2) retention in MOUD, and (3) opioid abstinence during MOUD. Methods We searched 3 databases (PubMed/MEDLINE, PsycINFO, CINAHL Complete) from 1/1/2000 to 7/28/2020 using key words and subject headings, and hand-searched reference lists of included articles. English-language studies of people with documented OUD/opioid use that reported a quantitative association between methamphetamine/amphetamine use or use disorder and an outcome of interest were included. Study data were extracted using a standardized template, and risk of bias was assessed for each study. Screening, inclusion, data extraction and bias assessment were conducted independently by 2 authors. Study characteristics and findings were summarized for each class of outcomes. Results Thirty-nine studies met inclusion criteria. Studies generally found that methamphetamine/amphetamine use or use disorder was negatively associated with receiving methadone and buprenorphine; 2 studies suggested positive associations with receiving naltrexone. Studies generally found negative associations with retention; most studies finding no association had small samples, and these studies tended to examine shorter retention timeframes and describe provision of adjunctive services to address substance use. Studies generally found negative associations with opioid abstinence during treatment among patients receiving methadone or sustained-release naltrexone implants, though observed associations may have been confounded by other polysubstance use. Most studies examining opioid abstinence during other types of MOUD treatment had small samples. Conclusions Overall, existing research suggests people who use methamphetamine/amphetamines may have lower receipt of MOUD, retention in MOUD, and opioid abstinence during MOUD. Future research should examine how specific policies and treatment models impact MOUD outcomes for these patients, and seek to understand the perspectives of MOUD providers and people who use both opioids and methamphetamine/amphetamines. Efforts to improve MOUD care and overdose prevention strategies are needed for this population.

Evaluation of the Impact of HIV Serostatus on the Hepatitis C Virus Care Cascade and Injection Drug Use Among Persons Initiating Medication Treatment for Opioid Use Disorder

“…However, there was no statistically significant change in self-reported or biologically confirmed stimulant use from baseline to 90 days among PWH or participants without HIV following initiation of MOUD. Previous studies of the effect of MOUD on stimulant use are conflicting, with some evidence that higher-dose buprenorphine (16 mg) may reduce cocaine use [ 39 ], while it has also been found that persons who use methamphetamine or amphetamine may have lower opioid abstinence and receipt of or retention on MOUD [ 21 ]. In our cohort, methamphetamine use was very low.…”

“…Medications for opioid use disorder (MOUD; eg, buprenorphine, methadone, and extended-release naltrexone) are an evidence-based strategy to address opioid addiction and are associated with reduced opioid IDU [ 14–20 ]. However, MOUD retention and opioid abstinence may be affected by co-stimulant use [ 21 ]. For PWID, MOUD is also associated with increased self-reported retention and uptake of DAA treatment; however, the HCV cascade of care highlights important gaps [ 22 ], and successful HCV treatment strategies involve a multidisciplinary effort in care coordination and case management, particularly for those with psychiatric illness or substance use disorder [ 23 , 24 ].…”

The use of methamphetamine in the probation population

“…The clinical data suggest that there has been a substantial increase in concomitant opioid and methamphetamine use (17,25,31), and mainly these two substances have led to a twin epidemic in the United States (16,31). Addiction specialists have begun to encounter increasing methamphetamine use in patients with opioid use disorder and the complicated clinical features, such as treatment nonadherence (36), injecting substance use (23), and associated risks such as viral hepatitis (37).…”

A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

“…Our study found amphetamine and polysubstance use were more common in the DRA-OPAT participants who did not complete IV antibiotic treatment, although the impact of specific substance used on completion of therapy could not be determined due to inadequate sample size. Recent data suggest methamphetamine use adversely affects MOUD receipt, retention, and opioid abstinence in patients with opioid use disorder [ 14 ].…”