Jackson Elise, Bach Paxton, Socias M Eugenia, Brooks Olivia M, Fairbairn Nadia, Rodrigues Myanca, Rosic Tea, Naji Leen, Jinks-Chang Samara, Nolan Seonaid, Chesney Amy, Reshetukha Taras, Samaan Zainab, Dennis Brittany B
British Columbia Centre on Substance Use, Vancouver, BC, Canada.
British Columbia Centre on Substance Use, Vancouver, BC, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Drug Alcohol Depend. 2025 Aug 1;273:112703. doi: 10.1016/j.drugalcdep.2025.112703. Epub 2025 May 16.
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.
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.
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).
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.
尽管北美地区未受监管的兴奋剂使用显著增加，但对于患有阿片类物质使用障碍（OUD）的个体使用兴奋剂的特征知之甚少。本研究旨在描述2013年至2020年期间接受阿片类激动剂治疗（OAT）的一组患者的兴奋剂使用模式。
开展了一项多中心前瞻性队列研究（2013 - 2020年），以招募来自加拿大安大略省57个门诊治疗中心、年龄大于16岁且患有OUD并接受OAT的患者。入组时收集的基线数据包括人口统计学信息、病史、当前的OAT处方以及物质使用模式。对参与者进行为期1年的随访，并定期进行尿液药物筛查（UDS）。主要结局是在队列水平上报告的基线兴奋剂使用情况在研究期间的时间变化，包括类型和频率。使用多变量逻辑回归来确定与兴奋剂使用可能性较高相关的患者因素。
2013年至2020年期间共招募了3476名参与者。在此期间，报告使用兴奋剂的受访者比例从18.0%增至32.9%（p值 = 0.06）。观察到的增加主要是由甲基苯丙胺使用的显著上升所驱动，从2.0%增至17.7%（p值 = 0.002）。每日使用兴奋剂的患者比例也有所增加，从2013年的0.4%增至2020年的7.6%（p值 = 0.002）。UDS结果证实了报告的使用增加情况。总体而言，兴奋剂使用可能性较高与较低的就业率（优势比[OR] = 0.72，95%置信区间[CI]：0.61，0.86）、每日芬太尼消费量（OR = 3.49，95% CI：1.87，6.51）以及注射吸毒（OR = 7.95，95% CI：6.38，9.91）相关。
在接受OAT治疗的OUD个体中，2013年至2020年观察到兴奋剂使用呈上升趋势，主要由甲基苯丙胺使用的显著增加所驱动。了解接受OAT治疗的患者并发物质使用的演变模式对于公共卫生应对、减少伤害计划和治疗规划至关重要。
