Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Little Rock, AR 72205, USA.
Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Little Rock, AR 72205, USA; Institute for Digital Health and Innovation, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
Drug Alcohol Depend. 2024 Sep 1;262:111403. doi: 10.1016/j.drugalcdep.2024.111403. Epub 2024 Jul 26.
Treatment for methamphetamine and other stimulants can be effective but treatment attrition and continued use are very high. Abstinence is the conventional outcome used to evaluate treatment success, but defining treatment success in this way misses opportunities to promote improved health even when abstinence is not achieved. Reducing methamphetamine and stimulant use without abstinence is associated with many positive outcomes. However, little is known about drug use patterns during treatment or trends in use over time.
We used the Treatment Episode Dataset-Discharges (TEDS-D) to identify treatment episodes that had a stimulant drug indicated as the primary substance of use (2017-2021; N=251,841; methamphetamine, cocaine, other amphetamines, or other stimulants). Our outcome was the change in the frequency of drug use between admission and discharge (decreased use with abstinence, decreased use without abstinence, increased use). We used multiple logistic regression to model a change in drug use frequency, predicted by year, stimulant type, and their interaction.
Nearly two-thirds of the sample (60 %) had methamphetamine indicated as the primary stimulant of use. There was a decrease in the predicted rate of abstinence over time and worsening trends were strongest among those using methamphetamine. Daily and periodic drug use at both admission and discharge (no change in use) became worse over time, particularly for those using methamphetamine.
Treatment outcomes worsened over time and declined fastest among those reporting methamphetamine. Abstinence was rare and most treatment clients did not change their drug use behavior. We recommend a renewed focus on evidence-based harm reduction while the nation's treatment systems continue grappling with the stimulant crises.
美沙酮和其他兴奋剂的治疗可能是有效的，但治疗流失率和持续使用率非常高。禁欲是评估治疗成功的常规结果，但以这种方式定义治疗成功会错失改善健康的机会，即使没有达到禁欲。减少美沙酮和兴奋剂的使用而不禁欲与许多积极结果相关。然而，人们对治疗期间的药物使用模式或随时间推移的使用趋势知之甚少。
我们使用治疗情节数据集-出院（TEDS-D）来确定将兴奋剂药物作为主要使用物质的治疗情节（2017-2021 年；N=251,841；美沙酮、可卡因、其他安非他命或其他兴奋剂）。我们的结果是入院和出院之间药物使用频率的变化（禁欲减少使用、不禁欲减少使用、增加使用）。我们使用多项逻辑回归来模拟药物使用频率的变化，由年份、兴奋剂类型及其相互作用预测。
近三分之二的样本（60%）将美沙酮列为主要兴奋剂。随着时间的推移，禁欲率呈下降趋势，在使用美沙酮的人群中，趋势最为明显。入院和出院时的每日和定期药物使用（使用无变化）随着时间的推移变得更糟，特别是对于使用美沙酮的人群。
治疗结果随着时间的推移而恶化，使用美沙酮的人群下降最快。禁欲率很低，大多数治疗患者没有改变他们的药物使用行为。我们建议在全国的治疗系统继续应对兴奋剂危机的同时，重新关注基于证据的减少伤害。
