Patients prescribed stimulants before initiating opioids had more than seven times higher odds of escalating opioid use compared with those whose doses decreased, according to a recent study. 

In a longitudinal cohort study, researchers investigated national trends in the coprescription of opioids and stimulants in the U.S. over a 10-year period from 2012 to 2021. The study aimed to assess the longitudinal association between stimulant use and opioid dosage escalation, using patient-level data from the MarketScan Commercial Claims and Encounters database, which includes more than 293 million unique patients.

The researchers, led by Seungyeon Lee of the Department of Computer Science and Engineering at The Ohio State University, developed a cohort of nearly 3 million patients who received at least two independent opioid prescriptions. The mean age of the cohort was 43.9 years (standard deviation = 13), and 43% identified as male. Patients were categorized into five opioid dose trajectories using group-based trajectory modeling: very low-dose (77.5%), low-dose decreasing (7%), low-dose increasing (11.6%), moderate-dose increasing (2.4%), and high-dose sustained use (1.5%).

Published in The Lancet Regional Health – Americas, the study found that 5.5% of patients (n = 160,243) received stimulant prescriptions during the study period. The results demonstrated a significant association between stimulant prescriptions and opioid dosage escalation. Patients who received stimulant prescriptions before their first opioid prescription had significantly higher odds of being in an escalating opioid dose trajectory (odds ratio [OR] = 7.58; 95% confidence interval [CI] = 6.14–9.35) compared with those whose opioid use decreased. Concurrent stimulant prescriptions were associated with increased opioid dose escalation (OR = 1.73; 95% CI = 1.40–2.14).

Regional variations were notable: the South exhibited the highest frequency of opioid prescriptions, with a mean of 4.19 prescriptions per patient, but had the lowest average morphine milligram equivalent (MME) at 8.99 mg. Conversely, the West had a higher average MME of 12.93 mg but a lower frequency of opioid prescriptions, averaging 3.80 per patient. Gender-based differences were also observed: male patients had higher mean daily MME values than female patients (10.6 mg vs. 9.19 mg) and a greater total MME (64.11 mg vs. 51.87 mg).

The findings highlight a significant positive association between stimulant prescriptions and increased opioid doses that contribute to the emerging “twin epidemic” of opioid and stimulant misuse in the U.S. health care system. The researchers emphasized the need for targeted interventions and policy changes to regulate coprescriptions and potentially mitigate the risk of escalating opioid use and associated adverse outcomes.

Full disclosures can be found in the published study.