Impact of recent stimulant use on treatment outcomes amongst individuals initiating medications for opioid use disorders: Secondary analysis of a multisite randomized controlled trial

Introduction

Illicit stimulant use among individuals initiating medication for opioid use disorder (MOUD) has significantly increased over the past decade. Co-use of these substances is associated with increased risk of mortality as well as worse treatment outcomes. This study examines the potential predictive role of stimulant urinalysis result at baseline on treatment retention and opioid and stimulant use outcomes amongst individuals initiating MOUD treatment.

Methods

This is a cross-sectional secondary analysis of data from a multi-site randomized clinical trial (CTN-0027). A total of 1269 individuals were randomized to receive 24 weeks of buprenorphine (n = 740) or methadone (n = 529) treatment across nine sites. Multiple linear and logistic regressions were conducted to determine the impact of baseline stimulant urinalysis results on treatment retention, and stimulant and opioid use outcomes.

Results

Individuals initiating MOUD with a stimulant negative urinalysis result at baseline submitted more negative stimulant (ꞵ=7.8; 95 % CI 6.8–8.7) and opioid (ꞵ=2.8; 95 % CI 1.8–3.8) urinalyses during treatment, were more likely to complete treatment (aOR=1.4; 95 % CI 1.1–1.7), and had better outcomes at six-month follow-up, measured as negative urinalysis for stimulant (aOR=5.3; 95 % CI 3.6–7.7), and opioid (aOR=1.8; 95 % CI 1.3–2.6).

Conclusion

Baseline stimulant use is associated with worse MOUD treatment outcomes, underscoring the need for novel integrated interventions designed to address opioid and stimulant co-use.