Roux Perrine, Faye Aissatou, Sagaon-Teyssier Luis, Donadille Cécile, Briand Madrid Laélia, Carrieri Maria Patrizia, Maradan Gwenaelle, Jauffret-Roustide Marie, Lalanne Laurence, Auriacombe Marc
Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
Drug Alcohol Rev. 2025 Jan;44(1):275-287. doi: 10.1111/dar.13955. Epub 2024 Oct 1.
The co-use of stimulants and opioids, including opioid agonist treatment (OAT), is very prevalent worldwide. A large body of data exists on the association between stimulant use and its health complications, and on OAT effectiveness among people with opioid use disorder. However, few data exist on stimulant-opioid co-use among people receiving OAT. Using data from the COSINUS cohort study, we investigated the association between the type of OAT and problematic stimulant use among persons who inject drugs (PWID).
COSINUS is a 12-month French cohort study of 665 PWID. Data were collected in face-to-face interviews at enrolment, at 6 and 12 months. We defined problematic stimulant use as daily use of and/or injecting stimulants. We used Bayesian model averaging (BMA) to identify factors associated with problematic stimulant use.
At baseline, 76% (n = 505) of the participants reported problematic stimulant use. The optimal model from the BMA estimation showed that, after adjusting on social precarity and daily injection, participants on prescribed morphine sulfate as an OAT (compared with methadone) and those who use daily unprescribed buprenorphine were less likely to report problematic stimulant use.
Our work highlights the high prevalence of problematic stimulant use among PWID in France but also the potential association between the type of OAT taken and stimulant use, by suggesting a protective effect of morphine sulfate on stimulant use. Since it has a higher intrinsic activity than other opioids, PWID on this OAT may be less interested in stimulants. Our findings warrant further investigation in clinical studies.
兴奋剂与阿片类药物的同时使用，包括阿片类激动剂治疗（OAT），在全球范围内非常普遍。关于兴奋剂使用与其健康并发症之间的关联以及阿片类药物使用障碍患者的OAT有效性，已有大量数据。然而，关于接受OAT治疗的人群中兴奋剂与阿片类药物同时使用的数据却很少。我们利用来自COSINUS队列研究的数据，调查了注射吸毒者（PWID）中OAT类型与问题性兴奋剂使用之间的关联。
COSINUS是一项针对665名PWID的为期12个月的法国队列研究。在入组时、6个月和12个月时通过面对面访谈收集数据。我们将问题性兴奋剂使用定义为每日使用和/或注射兴奋剂。我们使用贝叶斯模型平均法（BMA）来确定与问题性兴奋剂使用相关的因素。
在基线时，76%（n = 505）的参与者报告有问题性兴奋剂使用。BMA估计得出的最优模型显示，在对社会不稳定因素和每日注射情况进行调整后，接受处方硫酸吗啡作为OAT治疗的参与者（与美沙酮相比）以及每日使用非处方丁丙诺啡的参与者报告问题性兴奋剂使用的可能性较小。
我们的研究突出了法国PWID中问题性兴奋剂使用的高流行率，同时也表明了所接受的OAT类型与兴奋剂使用之间的潜在关联，提示硫酸吗啡对兴奋剂使用具有保护作用。由于其内在活性高于其他阿片类药物，接受这种OAT治疗的PWID可能对兴奋剂的兴趣较小。我们的研究结果值得在临床研究中进一步调查。
