(22) Effect of Buprenorphine/Naloxone and Methadone on Methamphetamine/Amphetamine Use

Background & Introduction: It has been suggested that opioid agonist therapy (OAT) may have a secondary benefit on reducing methamphetamine/amphetamine use. However, current evidence is limited and conflicting, and little is known on differential impacts of different OAT. The aim of this study was to examine the comparative effectiveness of buprenorphine/naloxone and methadone on methamphetamine/amphetamine use among individuals with prescription-type opioid use disorder (POUD) initiating OAT in Canada.

Methods: Data for this study were derived from a 24-week pan-Canadian pragmatic trial conducted between 2017 and 2020 comparing supervised methadone versus flexible take-home dosing buprenorphine/naloxone models of care among POUD. Generalized linear mixed models were used to evaluate the independent effect of type of treatment (i.e., methadone or buprenorphine/naloxone) and time in treatment (i.e., week 2 through 24, continuous) on methamphetamine/amphetamine use (measured by urine drug test and self-report using Timeline Follow Back).

Results: The sample included 210 participants that initiated OAT, of which 130 (61.9%) were using methamphetamine/amphetamine at baseline. In multivariable analysis, neither type of treatment treatment nor time in treatment were significantly associated with the odds of methamphetamine/amphetamine use (adjusted odds ratio [AOR] = 0.61, 95% confidence interval [CI] = 0.34 – 1.08, p = 0.092 and AOR = 0.73, CI = 0.40 – 1.28, p = 0.283, respectively). No interaction between type of treatment and time in treatment was observed for methamphetamine/amphetamine use (p = 0.367).

Conclusion & Discussion: Methamphetamine/amphetamine use was common among this sample of people with POUD initiating OAT in Canada. Over the 24-week study period, buprenorphine/naloxone and methadone did not impact methamphetamine/amphetamine use, thus suggesting no differential treatment impacts.

References:

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