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CTN Study Finds that Stimulant Use is a Barrier to Medication Treatment for Opioid Use Disorder

January 3, 2023
Meg Brunner, MLIS
Cook RR, Foot C, Arah OA, Humphreys K, Rudolph KE, Luo SX, Tsui JI, Levander XA, Korthuis PT. Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations. Addiction Science & Clinical Practice 2023;18:11.
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What’s the Question?

Co-use of opioids and stimulants, especially methamphetamine and cocaine, has been increasing and contributes to our growing overdose epidemic. Medications for opioid use disorder (MOUD), like buprenorphine and extended-release naltrexone (XR-NTX), are effective in reducing opioid use and preventing overdose – but does co-use of stimulants impact an individual’s initiation, engagement, and retention in MOUD treatment for their opioid use? And is there a difference between patients participating in a clinical trial and those in the “real world”?


How Was This Study Conducted?

SuboxoneResearchers looked at data from NIDA Clinical Trials Network protocols CTN-0051 (X:BOT) and CTN-0067 (CHOICES), as well as information pulled from the National Survey on Drug Use and Health (NSDUH), Treatment Episodes Dataset (TEDS), and the Rural Opioids Initiative (ROI). They focused in on associations between stimulant use and initiation of MOUD (buprenorphine or XR-NTX).

Results were then generalized to three target populations who would benefit from MOUD: housed individuals identifying the need for MOUD treatment (as identified by the NSDUH), adults entering OUD treatment (as identified in TEDS), and adults living in rural regions of the US with high rates of injection drug use (as identified in the ROI).


What Did Researchers Find Out?

Looking at the data, researchers noticed that regardless of the type of participant (whether they were in a randomized clinical trial or the “real world”), stimulant use was associated with a 25-40% reduction in the likelihood of starting treatment for opioid use disorder with medication (buprenorphine or XR-NTX). 

Several theories for this are proposed in the paper, including the fact that historically, clinical guidelines had discouraged buprenorphine treatment for people using other substances along with opioids (this was changed in 2020). Additionally, stigma from providers and others remains a major barrier to engagement with medication treatment. Stimulant use can impact someone’s motivation, resourcefulness, social network, or physical and psychological capacity to start MOUD treatment, too.


What are the Implications for the Workforce?

Knowing how common stimulant and opioid co-use is, providers should be aware of the added challenges in initiating this group of people in medication treatment for their opioid use disorder and be prepared to offer more intensive care. Researchers should also be aware of the fact that stimulant use can impact MOUD initiation in trial participants, as well, potentially impacting outcomes.

Efforts to identify effective treatments for stimulant use disorder need to be intensified and integrated with OUD care, as co-use of opioids and stimulants continues to grow. 

Meg Brunner, MLIS
CTN Dissemination Library & Northwest ATTC
March 2023