Receipt of Prescription Stimulant Medications after Drug-Related Poisoning Associated with Mixed Outcomes in Buprenorphine Treatment

Patients with opioid use disorder (OUD) have high rates of attention-deficit/hyperactivity disorder, as well as increasing rates of co-occurring stimulant use disorder, especially methamphetamine use disorder. Clinicians treating OUD must weigh the potential risks and benefits of prescribing stimulant medications to patients receiving buprenorphine for OUD. This retrospective recurrent-event cohort study used administrative claims data (2006–2016) to investigate the association between days with stimulant prescription and both drug-related poisonings and buprenorphine treatment retention in patients who had already experienced a drug-related poisoning.

• Among 22,946 individuals who were prescribed buprenorphine and experienced a drug-related poisoning, stimulant treatment days were associated with a 19% increased odds of subsequent drug-related poisoning (odds ratio [OR], 1.19), compared with no stimulant treatment.
• Stimulant treatment days were associated with 36% decreased odds of attrition from buprenorphine treatment (OR, 0.64).
• Buprenorphine treatment days were associated with a 38% decreased odds of drug-related poisoning (OR, 0.62).

Comments: The modest increase in per-day risk of drug-related poisoning associated with stimulant medication prescription was offset by the association between stimulant prescription and improved buprenorphine retention, which protects against overdose. Given the benefits of buprenorphine retention beyond overdose prevention, these data are reassuring that treatment with stimulant medications is not likely to increase risk substantially in patients receiving buprenorphine, although clinicians and patients should weigh both risks and benefits of this medication combination.

Joseph Merrill, MD, MPH

Reference: Mintz CM, Xu KY, Presnall NJ, et al. Analysis of stimulant prescriptions and drug-related poisoning risk among persons receiving buprenorphine treatment for opioid use disorder. JAMA Netw Open. 2022;5(5):e2211634.