Yerton Megan J, McCabe Connor J, Iles-Shih Matthew D, Tsui Judith I, Hallgren Kevin A
University of Washington School of Medicine, Seattle, WA, 98195, USA.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA.
Addict Sci Clin Pract. 2025 Aug 13;20(1):67. doi: 10.1186/s13722-025-00593-8.
Amphetamine-type stimulant use and overdoses have increased sharply across the US in recent years, largely driven by methamphetamine. Increased access to treatments for amphetamine-type stimulant use disorder (AT-StUD), including in primary care settings, is needed to mitigate these problems, yet effective behavioral treatments are often inaccessible and there are no FDA-approved medications for AT-StUD. In the current study, we characterize how often patients with clinically documented AT-StUD in predominantly rural-serving Pacific Northwest primary care clinics received medications that have been conditionally recommended in practice guidelines for treatment of AT-StUD.
Electronic health record data from 23 primary care clinics in the Pacific Northwest US were obtained through the Data QUEST network. Adult patients with clinically documented "other stimulant abuse" or "other stimulant dependence" diagnoses typically reflecting AT-StUD between 01/2017 and 12/2021 were included. Prescription records were used to identify orders for bupropion, mirtazapine, topiramate, naltrexone-bupropion combination, methylphenidate, dextroamphetamine, and modafinil. Statistical analyses quantified the percentage of patients with medication orders placed within one year after any documented AT-StUD diagnosis.
Patients (N = 963) were predominantly female (53.3%), White (81.7%), and non-Hispanic (70.5%). In total, 14.3% of patients received orders for a non-stimulant medication conditionally recommended in practice guidelines; 2.7% received orders for a stimulant medication. Consistent with clinical guidelines, medications were more often prescribed when patients had documented co-occurring disorders for which the medications could also be effective.
In this sample of rural-serving primary care clinics, approximately 1 in 7 primary care patients with AT-StUD received orders for medications with preliminary evidence of effectiveness. Efforts are needed to increase access to AT-StUD treatments within primary care. These efforts could include training health professionals to consider judicious use of pharmacotherapy consistent with clinical guidelines, increasing capacity for behavioral health services including contingency management, and continuing research on pharmacologic agents.
近年来，美国苯丙胺类兴奋剂的使用和过量使用急剧增加，主要由甲基苯丙胺驱动。为缓解这些问题，需要增加获得苯丙胺类兴奋剂使用障碍（AT-StUD）治疗的机会，包括在初级保健机构，但有效的行为治疗往往难以获得，且尚无FDA批准的用于治疗AT-StUD的药物。在本研究中，我们描述了在主要服务农村地区的太平洋西北地区初级保健诊所中，有临床记录的AT-StUD患者接受实践指南中有条件推荐药物治疗的频率。
通过数据探索网络获取了美国太平洋西北地区23家初级保健诊所的电子健康记录数据。纳入了2017年1月至2021年12月期间有临床记录的“其他兴奋剂滥用”或“其他兴奋剂依赖”诊断（通常反映AT-StUD）的成年患者。处方记录用于识别安非他酮、米氮平、托吡酯、纳曲酮-安非他酮组合、哌醋甲酯、右旋苯丙胺和莫达非尼的医嘱。统计分析量化了在任何有记录的AT-StUD诊断后一年内开具药物医嘱的患者百分比。
患者（N = 963）以女性（53.3%）、白人（81.7%）和非西班牙裔（70.5%）为主。总体而言，14.3%的患者接受了实践指南中有条件推荐的非兴奋剂药物医嘱；2.7%的患者接受了兴奋剂药物医嘱。与临床指南一致，当患者有记录的共病且这些药物对其也可能有效时，药物开具得更频繁。
在这个服务农村地区的初级保健诊所样本中，每7名患有AT-StUD的初级保健患者中约有1人接受了有初步有效性证据的药物医嘱。需要努力增加在初级保健机构中获得AT-StUD治疗的机会。这些努力可包括培训卫生专业人员考虑根据临床指南明智地使用药物治疗、增加包括应急管理在内的行为健康服务能力，以及继续开展药物制剂研究。
