Young Samantha, Fairbairn Nadia, Cui Zishan, Bach Paxton, Mok Wing Yin, Budau Juls, Slaunwhite Amanda, Ti Lianping, Hayashi Kanna, Nolan Seonaid
British Columbia Centre on Substance Use, Vancouver, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Addiction. 2025 Jun;120(6):1184-1194. doi: 10.1111/add.16760. Epub 2025 Jan 28.
We measured the association between prescribed stimulant medications and overdose among individuals receiving opioid agonist therapy (OAT) for opioid use disorder.
Retrospective cohort study using the British Columbia Provincial Overdose Cohort, a linked administrative database.
We used data from British Columbia, Canada, from January 2015 through February 2020.
In total, 9395 individuals contributed 18 273 person-years of follow-up while dispensed OAT.
We examined the association between stimulant prescription (primary exposure) and fatal or non-fatal overdose (primary outcome, allowing for recurrent events) after adjusting for potential confounders including sociodemographic characteristics and substance use patterns. As a secondary analysis, we evaluated type of OAT (full agonists involving methadone or slow-release oral morphine versus partial agonist involving buprenorphine/naloxone alone) as a potential effect modifier.
There were 1746 overdose events; 37 (2.1%) were fatal. Overall, there was no increased risk of overdose among individuals dispensed a stimulant medication while on OAT [adjusted Cox regression hazard ratio (AHR) = 1.13, 95% confidence interval (95% CI) = 0.86-1.49, P = 0.39]. When analyzed by type of OAT medication, for individuals on buprenorphine, dispensation of a stimulant medication was associated with a reduced risk of overdose (AHR = 0.47, 95% CI = 0.23-0.96, P = 0.037) while, for individuals on full agonist OAT, dispensation of a stimulant medication was associated with an increased risk of overdose (AHR = 1.51, 95% CI = 1.09-2.07, P = 0.012).
There does not appear to be an overall increased risk of overdose for individuals co-prescribed a stimulant medication with opioid agonist therapy (OAT). There appears to be a reduced risk of overdose for individuals dispensed buprenorphine with a stimulant medication compared with those dispensed buprenorphine alone, and an increased risk of overdose for individuals dispensed full agonist OAT (methadone or slow-release oral morphine) with a stimulant medication compared with those dispensed full agonist OAT alone.
我们测量了接受阿片类药物使用障碍阿片类激动剂治疗（OAT）的个体中，处方兴奋剂药物与药物过量之间的关联。
使用不列颠哥伦比亚省省级药物过量队列（一个关联的行政数据库）进行回顾性队列研究。
我们使用了加拿大不列颠哥伦比亚省2015年1月至2020年2月的数据。
共有9395名个体在接受OAT配药期间贡献了18273人年的随访数据。
在调整了包括社会人口统计学特征和物质使用模式等潜在混杂因素后，我们研究了兴奋剂处方（主要暴露因素）与致命或非致命药物过量（主要结局，允许复发事件）之间的关联。作为次要分析，我们评估了OAT的类型（涉及美沙酮或缓释口服吗啡的完全激动剂与仅涉及丁丙诺啡/纳洛酮的部分激动剂）作为潜在的效应修饰因素。
共发生1746起药物过量事件；37起（2.1%）为致命事件。总体而言，接受OAT治疗时同时配用兴奋剂药物的个体，药物过量风险并未增加[调整后的Cox回归风险比（AHR）=1.13，95%置信区间（95%CI）=0.86 - 1.49，P = 0.39]。按OAT药物类型分析时，对于使用丁丙诺啡的个体，配用兴奋剂药物与药物过量风险降低相关（AHR = 0.47，95%CI = 0.23 - 0.96，P = 0.037）；而对于使用完全激动剂OAT的个体，配用兴奋剂药物与药物过量风险增加相关（AHR = 1.51，95%CI = 1.09 - 2.07，P =
