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. 2022 May 2;5(5):e2211634.
doi: 10.1001/jamanetworkopen.2022.11634.

Analysis of Stimulant Prescriptions and Drug-Related Poisoning Risk Among Persons Receiving Buprenorphine Treatment for Opioid Use Disorder

Carrie M Mintz  1 , Kevin Y Xu  1 , Ned J Presnall  2 , Sarah M Hartz  2 , Frances R Levin  3   4 , Jeffrey F Scherrer  5   6 , Laura J Bierut  1 , Richard A Grucza  5   6
Affiliations

Analysis of Stimulant Prescriptions and Drug-Related Poisoning Risk Among Persons Receiving Buprenorphine Treatment for Opioid Use Disorder

Carrie M Mintz et al. JAMA Netw Open. .

Abstract

Importance: Stimulant medication use is common among individuals receiving buprenorphine for opioid use disorder (OUD). Associations between prescription stimulant use and treatment outcomes in this population have been understudied.

Objectives: To investigate whether use of prescription stimulants was associated with (1) drug-related poisoning and (2) buprenorphine treatment retention.

Design, setting, and participants: This retrospective, recurrent-event cohort study with a case-crossover design used a secondary analysis of administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Primary analyses were conducted from March 1 through August 31, 2021. Individuals aged 12 to 64 years with an OUD diagnosis and prescribed buprenorphine who experienced at least 1 drug-related poisoning were included in the analysis. Unit of observation was the person-day.

Exposures: Days of active stimulant prescriptions.

Main outcomes and measures: Primary outcomes were drug-related poisoning and buprenorphine treatment retention. Drug-related poisonings were defined using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes; treatment retention was defined by continuous treatment claims until a 45-day gap was observed.

Results: There were 13 778 567 person-days of observation time among 22 946 individuals (mean [SD] age, 32.8 [11.8] years; 50.3% men) who experienced a drug-related poisoning. Stimulant treatment days were associated with 19% increased odds of drug-related poisoning (odds ratio [OR], 1.19 [95% CI, 1.06-1.34]) compared with nontreatment days; buprenorphine treatment days were associated with 38% decreased odds of poisoning (OR, 0.62 [95% CI, 0.59-0.65]). There were no significant interaction effects between use of stimulants and buprenorphine. Stimulant treatment days were associated with decreased odds of attrition from buprenorphine treatment (OR, 0.64 [95% CI, 0.59-0.70]), indicating that stimulants were associated with 36% longer mean exposure to buprenorphine and its concomitant protection.

Conclusions and relevance: Among persons with OUD, use of prescription stimulants was associated with a modest increase in per-day risk of drug-related poisoning, but this risk was offset by the association between stimulant use and improved retention to buprenorphine treatment, which is associated with protection against overdose.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mintz reported receiving grants from the National Institute on Drug Abuse and nonfinancial support from National Center for Advancing Translational Sciences (NCATS) during the conduct of the study and receiving personal fees from the Missouri Chapter of the American College of Physicians continuing medical education talk on opioid use disorder management and the Texas Club of Internists continuing medical education talk on opioid use disorder outside the submitted work. Dr Presnall reported receiving personal fees from Plan Your Recovery, CB Programs LLC, and the Missouri Institute for Mental Health for consulting on opioid grants outside the submitted work. Dr Levin reported consulting for Major League Baseball, receiving grants from the National Institutes of Health (NIH) and Substance Abuse and Mental Health Services Administration (SAMHSA), receiving a salary from the New York State Psychiatric Institute, and receiving nonfinancial support from US World Meds, Alkermes plc, and Indivior outside the submitted work and serving as an uncompensated member of scientific advisory boards of Alkermes plc, Indivior, Novartis International AG, Teva Pharmaceutical Industries Ltd, and US WorldMeds LLC. Dr Bierut reported receiving grants from the NIH during the conduct of the study; being listed as an inventor for US Patent 8,080,371, “Markers for Addiction” covering the use of certain single-nucleotide variants in determining the diagnosis, prognosis, and treatment of addiction; and being a speaker bureau member for Imedex. Dr Grucza reported receiving grants from the NIH and Arnold Ventures LLC during the conduct of the study, consulting for Janssen Pharmaceuticals, and receiving personal fees for grant reviews from the NIH outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Development of Study Sample
Figure 2.
Figure 2.. Illustration of the Net Risk of Drug-Related Poisoning Among Persons With OUD Receiving Buprenorphine With and Without Co-use of Prescription Stimulants
DRP indicates drug-related poisoning.
See this image and copyright information in PMC

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