A systematic review and meta-analysis of medications for stimulant use disorders in patients with co-occurring opioid use disorders
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Background Stimulant (cocaine and/or methamphetamine) use has increased among people with opioid use disorder. We conducted a systematic review of medications for stimulant use disorders in this population.Methods We searched for randomized controlled trials in multiple databases through April 2019, and dual-screened studies using pre-specified inclusion criteria. Primary outcomes were abstinence defined as stimulant-negative urine screens for ≥3 consecutive weeks; overall use as the proportion of stimulant-negative urine specimens; and retention as the proportion of participants who completed treatment. We rated strength of evidence using established criteria and conducted meta-analyses of comparable interventions and outcomes.Results Thirty-four trials of 22 medications focused on cocaine use disorder in patients with opioid use disorder. Most studies enrolled participants stabilized on opioid maintenence therapy, generally methadone. None of the six studies that assessed abstinence found significant differences between groups. We found moderate-strength evidence that antidepressants (desipramine, bupropion, and fluoxetine) worsened retention. There was moderate-strength evidence that disulfiram worsened treatment retention (N = 605, RR 0.86, 95 % CI 0.77 to 0.95). We found low-strength evidence that psychostimulants (mazindol and dexamphetamine) may reduce cocaine use, though the difference was not statistically significant (standard mean difference 0.35 [95 % CI -0.05 to 0.74]). There was only 1 trial for methamphetamine use disorder, which showed insufficient-strength evidence for naltrexone.Conclusions Co-occurring stimulant/opioid use disorder is an important problem for targeting future research. Medication trials for methamphetamine use disorder are lacking in this population. Most of the medications studied for cocaine use were ineffective, although psychostimulants warrant further study.
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The current body of evidence supporting prescription stimulants for treating stimulant use disorders remains inconclusive.
“the current body of evidence supporting prescription stimulants for treating stimulant use disorders remains inconclusive [58,66,67,68,69].”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [67]
The Results section finds low-strength, statistically inconclusive evidence that psychostimulants may reduce cocaine use, and the Discussion says the small trials may not be replicable. The review is limited to patients with co-occurring opioid use disorder and provides little evidence on methamphetamine treatment, so it does not establish the state of the evidence for stimulant use disorders generally. Page numbers were not available in our copy. (LLM, conf=0.85)
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- Authors
- Chan, B., Freeman, M., Ayers, C., Korthuis, P. T., Paynter, R., Kondo, K., & Kansagara, D.
- Affiliations
- Oregon Health & Science University (US)
- Portland VA Medical Center (US)
- Corresponding author
- Chan, Brian
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 216
- Pages
- 108193
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC8562993
- OpenAlex
- W3046248416
- Cited by
- 56
- References
- 60
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 12 · 2022: 11 · 2021: 16
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality
- National Institute on Drug Abuse
- U.S. Department of Veterans Affairs
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- stimulant use disorder, opioid use disorder, cocaine dependence, methamphetamine dependence, co-occurring substance use disorders, pharmacotherapy, treatment retention, abstinence, antidepressants, disulfiram, psychostimulants, mazindol, d-amphetamine, naltrexone, methadone maintenance treatment, desipramine, bupropion, fluoxetine
- MeSH terms
- Central Nervous System Stimulants, Analgesics, Opioid, Antidepressive Agents, Cocaine, Female, Humans, Methadone, Naltrexone, Opioid-Related Disorders, Cocaine-Related Disorders
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