Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment

Abstract

Background A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients. Methods Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n = 20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results Participants reported a range of stimulant use types, including cocaine (n = 8), methamphetamine (n = 8), or both (n = 4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic). Conclusion In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.

Multiple comparison of different noninvasive brain stimulation and pharmacologic interventions in patients with methamphetamine use disorders: A network meta‐analysis of randomized controlled trials

“…1 and Table S3). 17,21,23,24,31,44–116 Finally, 22 RCTs were included (Table S4). 13–16,117–134 Figure 2 illustrates the entire geometric distribution of the treatment arms.…”

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

“… 26 Similar positive outcomes have been identified in pilot programs in Canada. 27 , 28 Furthermore, a 2021 systematic review 29 found that contingency management was associated with psychostimulant abstinence among people with OUD and STUD when provided alongside OAT.…”

“…For example, patients prescribed dextroamphetamine in an OAT clinic in the Netherlands had significant reductions in cocaine use, and significant improvements in physical health, mental health, and social functioning . Similar positive outcomes have been identified in pilot programs in Canada . Furthermore, a 2021 systematic review found that contingency management was associated with psychostimulant abstinence among people with OUD and STUD when provided alongside OAT.…”

Prescription psychostimulants as a harm reduction and treatment intervention for methamphetamine use disorder and the implications for nursing clinical practice: A scoping review of the literature

“…Participants seeking a substitution effect for energy, focus and withdrawal management identify dextroamphetamine as an efficient medication, while participants seeking euphoria from taking stimulants do not find dextroamphetamine effective in offering substitution for illicit stimulants (Palis et al, 2021). Participants also identified integrated services to facilitate medication access as an important factor when considering prescription psychostimulant treatment (Palis et al, 2021). However, barriers to implementation include the lack of access to take-home doses, requiring participants to take the medication at certain time frames that do not always offer relief of withdrawal symptoms or cravings (Palis et al, 2021).…”

“…Participants also identified integrated services to facilitate medication access as an important factor when considering prescription psychostimulant treatment (Palis et al, 2021). However, barriers to implementation include the lack of access to take-home doses, requiring participants to take the medication at certain time frames that do not always offer relief of withdrawal symptoms or cravings (Palis et al, 2021). It should also be noted that this research had a very unique and specific sample of participants who had concurrent opioid and stimulant use disorder diagnoses, and that findings may not be generalizable to people with different demographic profiles receiving treatment in other settings (Palis et al, 2021).…”