Prescription Stimulant and Illicit Stimulant Use: Implications for Substance Use Treatment

This session will feature new research by the Centers for Disease Control and Prevention (CDC) and latest activities in this space by the U.S. Food and Drug Administration (FDA). It will cover the toxicities of methamphetamine, which are markedly different from opioids, and how those differences affect responses to the overdose crisis, as well as review medications that show promise for treating methamphetamine use disorder.

The CDC presenters will address that limited data exist on risk factors for illicit stimulant use, including the association between prescription stimulant use/nonmedical use (NMU) and illicit stimulant use, among adults assessed for substance use disorder (SUD) treatment. They used 2017-2021 real-world data from adults assessed for SUD treatment using the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) Addiction Severity Index-Multimedia Version® tool. They analyzed associations between past 30-day prescription stimulant use as prescribed or NMU and past 30-day illicit stimulant use employing multivariable Poisson regression models. Separate models were run for past 30-day use of illicit stimulants, methamphetamine, and cocaine. They explored problem severity across seven biopsychosocial domains (e.g., drug, psychiatric, family) by past 30-day prescription stimulant use/NMU and illicit stimulant use categories. Among 218,981 assessments, 1.8% reported prescription stimulant NMU; 1.6% reported prescription stimulant use as prescribed. Past 30-day prescription stimulant NMU (vs. no use) was associated with past 30-day illicit stimulant use (adjusted prevalence ratio [aPR] [95% CI]: 2.67 [2.59, 2.75]), methamphetamine use (aPR: 2.81 [2.71, 2.92]), and cocaine use (aPR: 3.53 [3.33, 3.74]). Prescription stimulant use as prescribed (vs. no use) was associated with lower prevalence of past 30-day illicit stimulant use. Assessments reporting prescription stimulant NMU (vs. no use, or use as prescribed) appeared more likely to have moderate to extreme problem scores across all biopsychosocial domains, indicating a greater need for treatment or assistance. Assessments reporting prescription stimulant use as prescribed or NMU frequently reported opioids, alcohol, or other substances as their primary substance problem. Adults who use illicit stimulants/NMU prescription stimulants may benefit from care addressing polysubstance use and including mental health, social, and recovery support services.