A study published in The Lancet Regional Health - Americas has revealed alarming trends in the co-prescription of opioids and stimulants in the United States, raising concerns about a "twin epidemic" that could further fuel the national substance use crisis. The research, conducted by experts from The Ohio State University and Harvard Medical School, analyzed 10 years of prescription data from nearly 2.9 million patients and found a strong association between stimulant use and escalating opioid doses.
The study, spanning from 2012 to 2021, leveraged data from MarketScan, one of the largest U.S. health insurance databases, to track opioid prescribing patterns. The researchers identified five distinct opioid dose trajectories, ranging from very low-dose users to those with high-dose sustained use. Notably, patients who received stimulant prescriptions were significantly more likely to be in the higher-dose opioid groups, with an odds ratio of 7.58 for opioid dose escalation when stimulants were prescribed before opioid initiation.
Geographic disparities were also evident, with the South and West regions of the U.S. exhibiting higher total opioid doses compared to the Northeast and North Central regions. Additionally, males were found to receive opioids at higher doses than females, consistent with previous research highlighting gender-based differences in pain management and prescribing practices.
The study's findings underscore a critical gap in U.S. healthcare regulations, as there are currently no national restrictions on prescribing stimulants to patients undergoing opioid treatment. In contrast, some European countries, like Norway, have implemented strict guidelines limiting stimulant prescriptions for individuals with substance use disorders or those in opioid maintenance programs.
This research contributes vital evidence to ongoing discussions about opioid prescribing policies and the risks associated with co-use of stimulants and opioids. The study authors urge policymakers and healthcare providers to consider these findings when developing strategies to curb the opioid crisis and address the rising rates of polysubstance use.
The full study is available here: https://doi.org/10.1016/j.lana.2025.101030 https://doi.org/10.1016/j.lana.2025.101030
If you're interested in such publications, please react and leave comments