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. 2025 Apr 6:15:100330.
doi: 10.1016/j.dadr.2025.100330. eCollection 2025 Jun.

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

Cari Coles  1 , Courtney Batts  1 , Joanne Bae  1 , Gabriela León  1 , Alex Schmidt  1   2 , Sterling M McPherson  1   2 , Crystal L Smith  1   2 , André C Miguel  1   2
Affiliations

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

Cari Coles et al. Drug Alcohol Depend Rep. .

Abstract

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.

Keywords: Buprenorphine; Methadone; Opioid use disorder; Stimulant use disorder; Treatment.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sterling M. McPherson reports a relationship with Alkermes Inc that includes: consulting or advisory. Sterling M. McPherson reports a relationship with Altimmune Inc that includes: consulting or advisory. Sterling M. McPherson reports a relationship with Idorsia Pharmaceuticals Ltd that includes: consulting or advisory. Sterling M. McPherson reports a relationship with Managed Health Connections that includes: funding grants. Sterling M. McPherson reports a relationship with Optimize Health that includes: funding grants. Sterling M. McPherson is an Associate Editor at Drug and Alcohol Dependence Reports but was not involved in the management or review of this manuscript. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Co-author Sterling M. McPherson has the following disclosure: Sterling M. McPherson is an Associate Editor at Drug and Alcohol Dependence Reports but was not involved in the management or review of this manuscript. He has consulted for Alkermes, Altimmune, and Idorsia biopharmaceutical companies. He has also received funding from Managed Health Connections and Optimize Health that originated with NIH. This funding is in no way related to what is reported here. All other authors have no further disclosures.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival analysis: Treatment Retention by baseline stimulant UA result.
See this image and copyright information in PMC

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