Stimulant use predicts high-risk substance use behaviors during medication treatment for opioid use disorder

Background The fourth wave of the overdose epidemic has been characterized by co-utilization of opioids and stimulants. This combined use is associated with high-risk behaviors, including heroin and intravenous drug use. Because research in real-world settings is limited, the objective of this study was to examine the impact of stimulant use before and during treatment for opioid use disorder on high-risk behaviors (intravenous opioid or stimulant use, heroin use). Method The current study included patients who initiated either methadone or buprenorphine from a statewide network of providers in Texas from May 20, 2020 to August 31, 2024. They were all uninsured/underinsured and living below the federal poverty line. We utilized two logistic regressions to examine whether stimulant use before or during treatment predicted heroin use or intravenous stimulant or opioid use. Results In total, 2848 patients were included in this study (M_age = 42.5 [SD = 12.2], 41.5% female, 82.2% White, and 33.6% Hispanic/Latino). Patterns of substance use at treatment initiation and during treatment, respectively, included: stimulant use (17.1% and 11.3%), intravenous stimulant or opioid use (39.0% and 36.6%), and heroin use (33.6% and 24.6%). Analyses showed that stimulant use during treatment predicted heroin use during treatment, and stimulant use both before and during treatment predicted intravenous use during treatment. Conclusions Separately analyzing stimulant use at treatment initiation and during treatment indicated a time-specific association between stimulant use and high-risk behaviors. Addressing stimulant use concurrent with opioid use will help reduce high-risk behaviors and may improve the prognosis of those using opioids and stimulants.