TY - JOUR
AU - M. M. Kalmin
AU - C. Crowley
AU - A. Bilder
AU - C. M. McCullough
AU - R. Weir
AU - B. A. Griffin
AU - M. Komaromy
AU - K. E. Watkins
A1 - 
AB - BACKGROUND: Among individuals with opioid use disorder (OUD) and co-occurring mental illness, stimulant co-use may be associated with more severe symptoms and less treatment utilization. We sought to understand the association of stimulant use with social needs and OUD and mental illness severity and treatment. METHODS: This cross-sectional study used baseline data from a randomized controlled trial of collaborative care for primary care patients with OUD and co-occurring depression and/or posttraumatic stress disorder (PTSD). We categorized stimulant use (cocaine/methamphetamine) into daily use (20 or more days), non-daily use (1-19 days), and no use (0 days). We conducted comparisons across measures of social needs and OUD and mental illness severity and treatment through one-way analysis of variance for continuous variables and chi-square tests for categorical/binary variables. RESULTS: 123 (15.4%) participants used stimulants daily, 164 (20.6%) reported non-daily use, and 510 (64%) used no stimulants. When comparing participants by stimulant use, we found differences in education (p = 0.020), housing status (p < 0.001), legal problems (p < 0.001), recent overdose (p < 0.001), overdose risk (p < 0.001), MOUD use (p < 0.001), depression/PTSD symptoms (p < 0.001), and receipt of therapy (p = 0.004) or medication (p < 0.001) for depression/PTSD with all differences demonstrating more unmet social needs, greater OUD and mental illness severity, and lower treatment utilization for participants using stimulants. CONCLUSIONS: Among primary care patients with OUD and co-occurring depression/PTSD, individuals using stimulants experienced a higher disease burden and decreased utilization of care across multiple measures. These associations suggest that clinicians should specifically address stimulant use in the context of co-occurring OUD and mental illness.
AD - RAND, 1776 Main Street, Santa Monica, CA, 90403, United States of America. Electronic address: mariahk@rand.org.; RAND, 1776 Main Street, Santa Monica, CA, 90403, United States of America.; RAND, 1200 South Hayes Street, Arlington, VA, 22202, United States of America.; Boston University, Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States of America.
AN - 42035890
BT - J Subst Use Addict Treat
C5 - Opioids & Substance Use
DA - 09/2026
DO - 10.1016/j.josat.2026.209997
DP - NLM
ET - 20260424
JF - J Subst Use Addict Treat
LA - eng
N2 - BACKGROUND: Among individuals with opioid use disorder (OUD) and co-occurring mental illness, stimulant co-use may be associated with more severe symptoms and less treatment utilization. We sought to understand the association of stimulant use with social needs and OUD and mental illness severity and treatment. METHODS: This cross-sectional study used baseline data from a randomized controlled trial of collaborative care for primary care patients with OUD and co-occurring depression and/or posttraumatic stress disorder (PTSD). We categorized stimulant use (cocaine/methamphetamine) into daily use (20 or more days), non-daily use (1-19 days), and no use (0 days). We conducted comparisons across measures of social needs and OUD and mental illness severity and treatment through one-way analysis of variance for continuous variables and chi-square tests for categorical/binary variables. RESULTS: 123 (15.4%) participants used stimulants daily, 164 (20.6%) reported non-daily use, and 510 (64%) used no stimulants. When comparing participants by stimulant use, we found differences in education (p = 0.020), housing status (p < 0.001), legal problems (p < 0.001), recent overdose (p < 0.001), overdose risk (p < 0.001), MOUD use (p < 0.001), depression/PTSD symptoms (p < 0.001), and receipt of therapy (p = 0.004) or medication (p < 0.001) for depression/PTSD with all differences demonstrating more unmet social needs, greater OUD and mental illness severity, and lower treatment utilization for participants using stimulants. CONCLUSIONS: Among primary care patients with OUD and co-occurring depression/PTSD, individuals using stimulants experienced a higher disease burden and decreased utilization of care across multiple measures. These associations suggest that clinicians should specifically address stimulant use in the context of co-occurring OUD and mental illness.
PY - 2026
SN - 2949-8767 (Print); 2949-8759
SP - 209997
ST - Stimulant use and increased severity of opioid use disorder and mental illness in patients with co-occurring disorders
T1 - Stimulant use and increased severity of opioid use disorder and mental illness in patients with co-occurring disorders
T2 - J Subst Use Addict Treat
TI - Stimulant use and increased severity of opioid use disorder and mental illness in patients with co-occurring disorders
U1 - Opioids & Substance Use
U3 - 10.1016/j.josat.2026.209997
VL - 188
VO - 2949-8767 (Print); 2949-8759
Y1 - 2026
ER -