Megan J Yerton, Connor J McCabe, Matthew D Iles-Shih, Judith I Tsui, Kevin A Hallgren
{"title":"太平洋西北地区农村初级保健诊所对安非他明类兴奋剂使用障碍患者的处方药治疗。","authors":"Megan J Yerton, Connor J McCabe, Matthew D Iles-Shih, Judith I Tsui, Kevin A Hallgren","doi":"10.1186/s13722-025-00593-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Amphetamine-type stimulant use and overdoses have increased sharply across the US in recent years, largely driven by methamphetamine. Increased access to treatments for amphetamine-type stimulant use disorder (AT-StUD), including in primary care settings, is needed to mitigate these problems, yet effective behavioral treatments are often inaccessible and there are no FDA-approved medications for AT-StUD. In the current study, we characterize how often patients with clinically documented AT-StUD in predominantly rural-serving Pacific Northwest primary care clinics received medications that have been conditionally recommended in practice guidelines for treatment of AT-StUD.</p><p><strong>Methods: </strong>Electronic health record data from 23 primary care clinics in the Pacific Northwest US were obtained through the Data QUEST network. Adult patients with clinically documented \"other stimulant abuse\" or \"other stimulant dependence\" diagnoses typically reflecting AT-StUD between 01/2017 and 12/2021 were included. Prescription records were used to identify orders for bupropion, mirtazapine, topiramate, naltrexone-bupropion combination, methylphenidate, dextroamphetamine, and modafinil. Statistical analyses quantified the percentage of patients with medication orders placed within one year after any documented AT-StUD diagnosis.</p><p><strong>Results: </strong>Patients (N = 963) were predominantly female (53.3%), White (81.7%), and non-Hispanic (70.5%). In total, 14.3% of patients received orders for a non-stimulant medication conditionally recommended in practice guidelines; 2.7% received orders for a stimulant medication. Consistent with clinical guidelines, medications were more often prescribed when patients had documented co-occurring disorders for which the medications could also be effective.</p><p><strong>Conclusions: </strong>In this sample of rural-serving primary care clinics, approximately 1 in 7 primary care patients with AT-StUD received orders for medications with preliminary evidence of effectiveness. Efforts are needed to increase access to AT-StUD treatments within primary care. These efforts could include training health professionals to consider judicious use of pharmacotherapy consistent with clinical guidelines, increasing capacity for behavioral health services including contingency management, and continuing research on pharmacologic agents.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"67"},"PeriodicalIF":3.2000,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344905/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prescribed medications for patients with amphetamine-type stimulant use disorder seen in rural-serving Pacific Northwest primary care clinics.\",\"authors\":\"Megan J Yerton, Connor J McCabe, Matthew D Iles-Shih, Judith I Tsui, Kevin A Hallgren\",\"doi\":\"10.1186/s13722-025-00593-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Amphetamine-type stimulant use and overdoses have increased sharply across the US in recent years, largely driven by methamphetamine. Increased access to treatments for amphetamine-type stimulant use disorder (AT-StUD), including in primary care settings, is needed to mitigate these problems, yet effective behavioral treatments are often inaccessible and there are no FDA-approved medications for AT-StUD. In the current study, we characterize how often patients with clinically documented AT-StUD in predominantly rural-serving Pacific Northwest primary care clinics received medications that have been conditionally recommended in practice guidelines for treatment of AT-StUD.</p><p><strong>Methods: </strong>Electronic health record data from 23 primary care clinics in the Pacific Northwest US were obtained through the Data QUEST network. Adult patients with clinically documented \\\"other stimulant abuse\\\" or \\\"other stimulant dependence\\\" diagnoses typically reflecting AT-StUD between 01/2017 and 12/2021 were included. Prescription records were used to identify orders for bupropion, mirtazapine, topiramate, naltrexone-bupropion combination, methylphenidate, dextroamphetamine, and modafinil. Statistical analyses quantified the percentage of patients with medication orders placed within one year after any documented AT-StUD diagnosis.</p><p><strong>Results: </strong>Patients (N = 963) were predominantly female (53.3%), White (81.7%), and non-Hispanic (70.5%). In total, 14.3% of patients received orders for a non-stimulant medication conditionally recommended in practice guidelines; 2.7% received orders for a stimulant medication. Consistent with clinical guidelines, medications were more often prescribed when patients had documented co-occurring disorders for which the medications could also be effective.</p><p><strong>Conclusions: </strong>In this sample of rural-serving primary care clinics, approximately 1 in 7 primary care patients with AT-StUD received orders for medications with preliminary evidence of effectiveness. Efforts are needed to increase access to AT-StUD treatments within primary care. These efforts could include training health professionals to consider judicious use of pharmacotherapy consistent with clinical guidelines, increasing capacity for behavioral health services including contingency management, and continuing research on pharmacologic agents.</p>\",\"PeriodicalId\":54223,\"journal\":{\"name\":\"Addiction Science & Clinical Practice\",\"volume\":\"20 1\",\"pages\":\"67\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-08-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344905/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Addiction Science & Clinical Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13722-025-00593-8\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SUBSTANCE ABUSE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Addiction Science & Clinical Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13722-025-00593-8","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SUBSTANCE ABUSE","Score":null,"Total":0}
Prescribed medications for patients with amphetamine-type stimulant use disorder seen in rural-serving Pacific Northwest primary care clinics.
Background: Amphetamine-type stimulant use and overdoses have increased sharply across the US in recent years, largely driven by methamphetamine. Increased access to treatments for amphetamine-type stimulant use disorder (AT-StUD), including in primary care settings, is needed to mitigate these problems, yet effective behavioral treatments are often inaccessible and there are no FDA-approved medications for AT-StUD. In the current study, we characterize how often patients with clinically documented AT-StUD in predominantly rural-serving Pacific Northwest primary care clinics received medications that have been conditionally recommended in practice guidelines for treatment of AT-StUD.
Methods: Electronic health record data from 23 primary care clinics in the Pacific Northwest US were obtained through the Data QUEST network. Adult patients with clinically documented "other stimulant abuse" or "other stimulant dependence" diagnoses typically reflecting AT-StUD between 01/2017 and 12/2021 were included. Prescription records were used to identify orders for bupropion, mirtazapine, topiramate, naltrexone-bupropion combination, methylphenidate, dextroamphetamine, and modafinil. Statistical analyses quantified the percentage of patients with medication orders placed within one year after any documented AT-StUD diagnosis.
Results: Patients (N = 963) were predominantly female (53.3%), White (81.7%), and non-Hispanic (70.5%). In total, 14.3% of patients received orders for a non-stimulant medication conditionally recommended in practice guidelines; 2.7% received orders for a stimulant medication. Consistent with clinical guidelines, medications were more often prescribed when patients had documented co-occurring disorders for which the medications could also be effective.
Conclusions: In this sample of rural-serving primary care clinics, approximately 1 in 7 primary care patients with AT-StUD received orders for medications with preliminary evidence of effectiveness. Efforts are needed to increase access to AT-StUD treatments within primary care. These efforts could include training health professionals to consider judicious use of pharmacotherapy consistent with clinical guidelines, increasing capacity for behavioral health services including contingency management, and continuing research on pharmacologic agents.
期刊介绍:
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use.
Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations.
Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.