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

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.

Factors associated with obtaining prescribed safer supply among people accessing harm reduction services: findings from a cross-sectional survey

“…Furthermore, in the absence of expansion of new medications, there are aspects of implementation of currently available medications that could be shifted to better meet needs. For example, a qualitative study of patients receiving dextroamphetamine (prescription psychostimulant) found that patients wanted to receive higher doses, with faster titration, and have access to take-home doses (27). There is growing evidence to support the safety and effectiveness of prescribed psychostimulants when provided in robust doses (> 60mg or more per day)(28).…”

Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

“…In BC and Canada, alternatives to illicit stimulants have been prescribed in a small number of settings and programs, with positive effects. For example, dextroamphetamine has been provided in a clinic in Vancouver since 2016 with observed reductions in illicit stimulant use and improved health outcomes [33,34]. In 2021, residents of a COVID-19 isolation hotel in Halifax who were using illicit stimulants were provided dextroamphetamine and methylphenidate with no reported cases of overdose or adverse events [35].…”