Literature Collection

AIMS: Stimulant use disorder contributes to a substantial worldwide burden of disease, although evidence-based treatment options are limited. This systematic review of reviews aims to: (i) synthesize the available evidence on both psychosocial and pharmacological interventions for the treatment of stimulant use disorder; (ii) identify the most effective therapies to guide clinical practice, and (iii) highlight gaps for future study. METHODS: A systematic database search was conducted to identify systematic reviews and meta-analyses. Eligible studies were those that followed standard systematic review methodology and assessed randomized controlled trials focused on the efficacy of interventions for stimulant use disorder. Articles were critically appraised using an assessment tool adapted from Palmeteer et al. and categorized for quality as 'core' or 'supplementary' reviews. Evidence from the included reviews were further synthesized according to pharmacological or non-pharmacological management themes. RESULTS: Of 476 identified records, 29 systematic reviews examining eleven intervention modalities were included. The interventions identified include: contingency management, cognitive behavioural therapy, acupuncture, antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine, and psychostimulants. There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder. Psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence to support or discount their use. Results of this review do not support the use of all other treatment options. CONCLUSIONS: The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder. Although evidence to date is insufficient to support the clinical use of psychostimulants, our results demonstrate potential for future research in this area. Given the urgent need for effective pharmacological treatments for stimulant use disorder, high-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed.

BACKGROUND: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. OBJECTIVE: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. METHODS: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. RESULTS: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). CONCLUSIONS: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.