Trends in stimulant use among patients with opioid use disorder receiving substance use treatment: Findings from a prospective cohort study from 2013 to 2020.
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OBJECTIVES: Despite significant rises in unregulated stimulant use across North America, little is known about the characteristics of stimulant use among individuals with opioid use disorder (OUD). This study sought to describe patterns of stimulant use among a cohort of patients receiving opioid agonist therapy (OAT) from 2013 to 2020. METHODS: A multi-center prospective cohort study (2013-2020) was undertaken to recruit patients > 16 years of age or older with OUD receiving OAT from 57 outpatient treatment centers in Ontario, Canada. Baseline data collected upon enrollment included demographics, medical history, current OAT prescription, and substance use patterns. Participants were followed for 1 year, with regular urine drug screens (UDS). The primary outcome was temporal change in baseline stimulant use reported at a cohort level, including type and frequency, over the study period. Multivariable logistic regressions were used to identify patient factors associated with higher likelihood of stimulant use. RESULTS: A total of 3476 participants were recruited between 2013 and 2020. The percentage of respondents reporting stimulant use increased from 18.0 % to 32.9 % (p-value 0.06) during this time. The observed increase was driven by a significant rise in crystal methamphetamine use from 2.0 % to 17.7 % (p-value 0.002). The proportion of patients using stimulants daily also increased, from 0.4 % in 2013 to 7.6 % in 2020 (p-value 0.002). The reported increase in use was corroborated by UDS findings. Overall, higher likelihood of stimulant use was associated with lower rates of employment (Odds ratio [OR] = 0.72, 95 % Confidence Interval [CI]: 0.61, 0.86), daily fentanyl consumption (OR = 3.49, 95 % CI: 1.87, 6.51) and injection drug use (OR = 7.95, 95 % CI: 6.38, 9.91). CONCLUSIONS: Among individuals receiving OAT for OUD, an increasing trend in stimulant use was observed from 2013 to 2020, driven primarily by the significant rise in crystal methamphetamine use. Understanding the evolving patterns of concurrent substance use in patients on OAT is essential for public health responses, harm reduction programs and treatment planning.
