Substance Use
Opioid-Stimulant Co-Use and Treatment Decisions: Evidence from 2023 U.S. First-Time Substance Use Treatment Admissions Patrico Tyrell* Patrico Tyrell Tyrell Department of Epidemiology and Biostatistics, School of Public Health, University at Albany (SUNY)
Background: Polysubstance use involving opioids and stimulants is increasing and complicates treatment decisions. Prior research suggests that stimulant co-use is associated with lower medication for opioid use disorder (MOUD) initiation and poorer treatment retention. However, it remains unclear whether opioid-stimulant co-use affects treatment allocation at admission in national data. This study examined whether co-use was associated with MOUD receipt and placement into intensive 24-hour treatment settings at admission.
Methods: Data were analyzed from the 2023 Treatment Episode Data Set-Admissions (TEDS-A), including 391,697 first-time admissions (aged ≥12 years) with opioid use across all 50 states, DC, and Puerto Rico. Opioid-stimulant co-use was defined as reporting at least one opioid and one stimulant at admission. Outcomes were MOUD receipt and 24-hour treatment placement (detoxification, inpatient, or residential care). Logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), controlling for age, sex, race/ethnicity, and psychiatric comorbidity.
Results: Among the sample, 8.8% (n=34,415) reported opioid-stimulant co-use. Co-use was associated with substantially higher odds of MOUD receipt (aOR=3.97, 95% CI: 3.86–4.10) and 24-hour treatment placement (aOR=1.82, 95% CI: 1.77–1.87) compared to opioid use alone. Patterns remained consistent when stratified by sex.
Conclusions: Opioid-stimulant co-use is associated with more intensive treatment at admission, contradicting prior concerns that stimulant co-use leads to withholding of MOUD at admission and suggesting the treatment system recognizes co-use as a severity marker. This pattern may reflect triage practices in publicly funded treatment systems rather than longer-term engagement or retention. However, longitudinal studies are needed to determine whether this intensive approach improves patient outcomes. These findings have direct implications for treatment access, program planning, and retention strategies in publicly funded systems.