For patients with opioid use disorder (OUD) taking buprenorphine, prescribing a stimulant medication may be a double-edged sword.
Stimulants may lead to better engagement and retention in buprenorphine treatment, which is associated with a host of health benefits, but this may come at a cost of a modest increase in drug-related overdose risk, new research suggests.
"It's important for clinicians to weigh both the potential risks and benefits of prescribing stimulants to people with opioid use disorder," co-first author Carrie Mintz, MD, assistant professor of psychiatry, Washington University School of Medicine, St. Louis, Missouri, told Medscape Medical News.
The study was published online May 11 in JAMA Network Open.
Common Dilemma
Stimulant medications are often prescribed for people taking buprenorphine for OUD, but there is a lack of evidence on risks and benefits to guide decision-making.
Using large insurance claims databases, Mintz and colleagues examined associations between prescription stimulant use and two clinically relevant OUD-related outcomes: drug-related poisonings and buprenorphine treatment retention.
The cohort included 22,946 individuals (mean age, 32.8 years; 49.7% women) with OUD who were receiving buprenorphine treatment and had a history of at least one drug-related poisoning.
Prescription stimulant use was associated with a modest 19% increased odds of drug-related overdose (odds ratio [OR], 1.19; 95% CI, 1.06 - 1.34) compared with nonuse.
