Use of amphetamine-type stimulants among emergency department patients with untreated opioid use disorder.

Concurrent use of amphetamine-type stimulants among individuals with opioid use disorder can exacerbate social and medical harms, including overdose risk. This study evaluated rates of amphetamine-type stimulant use among patients with untreated opioid use disorder presenting at emergency departments in Baltimore, MD; New York, NY; Cincinnati, OH; and Seattle, WA.

Emergency department (ED) patients with untreated opioid use disorder (N=396) and enrolled between February 2017 and January 2019 in a multisite hybrid type III implementation science study (CTN-0069, Opioid Use Disorder in the Emergency Department) were evaluated for concurrent amphetamine-type stimulant use. Individuals with urine tests positive for methamphetamine, amphetamine, or both were compared with amphetamine-type stimulant-negative patients.

Overall, 38% of patients (150/396) were amphetamine-type stimulant positive; none reported receiving prescribed amphetamine or methamphetamine medications. Amphetamine-type stimulant-positive versus -negative patients were younger: mean age was 36 years versus 40 years. Other differences: 69% versus 46% were white, 65% versus 54% were unemployed, 67% versus 49% had unstable housing, 47% versus 25% reported an incarceration during 1 year before study admissions, 60% versus 45% were hepatitis C positive, 79% versus 47% reported drug injection during 1 month before study admission, and 42% versus 29% presented to the ED for an injury. Lower proportions of amphetamine-type stimulant-positive patients had cocaine-positive urine test results (33% versus 52%) and reported seeking treatment for substance use problems as a reason for their ED visit (10% versus 19%). All comparisons were statistically significant.

Conclusions: Amphetamine-type stimulant use among ED patients with untreated opioid use disorder was associated with distinct sociodemographic, social, and health factors. Improved ED-based screening, intervention, and referral protocols for patients with opioid use disorder and amphetamine-type stimulant use are needed.

Related protocols: CTN-0069