Stimulants include psychostimulants like methamphetamine and methylphenidates (for example, Adderall®, Dexedrine®, and Ritalin®), as well as cocaine. Overdose deaths due to stimulants, and particularly stimulants in combination with fentanyl and other opioids, have been increasing rapidly.
Data source: California Opioid Dashboard. California Department of Public Health - Substance and Addiction Prevention Branch. CDPH Center for Health Statistics and Informatics Vital Statistics - Multiple Cause of Death and California Comprehensive Death Files.
As of 2020, the California psychostimulant-related overdose death rate was 11.0 and the cocaine-related overdose death rate was 2.2 deaths per 100,000 residents. These rates represent 51.1% and 37.6% increases, respectively, over the prior year. The increase in overdose death rates mirror national trends, which have highlighted the need to address the use of multiple substances – not just opioids – as part of the overdose crisis.
In response to this growing need, in 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) added flexibility to State Opioid Response (SOR) funding to allow states to address stimulant use. The California Department of Health Care Services (DHCS) has added treatment and prevention of stimulant use disorders as a focus to many of its SOR-funded projects.
As of June 2021, over 4,000 patients started treatment for stimulant use in SOR-funded programs and organizations. Treatments included contingency management (i.e., motivational incentives), other behavioral interventions (for example, cognitive behavioral therapy), and exercise-based interventions. The growth in the number of patients receiving treatment over time is promising.
UCLA ISAP has launched the Stimulant Use Disorder Projects to evaluate how California programs and clinics are addressing stimulant use disorders. Because specialty and primary care settings each have distinct patient flows, staffing configurations, objectives, work cultures and approaches to patient care, UCLA has developed three projects that address the needs of these diverse settings. Project 1 trains and coaches providers in SUD specialty care programs to deliver the TRUST model, a manualized, research-supported approach to enhancing and improving the treatment experience of individuals with stimulant use disorders. Projects 2 and 3 are more exploratory which aim to better understand current clinical practices being used to address stimulant use in general primary care settings (project 2) and in those that have established DATA 2000-waivered prescribers/MAT programs (project 3). These exploratory projects will identify barriers and facilitators to adopting evidence-based practices and discuss the training and supports needed to facilitate their uptake. The goal is to develop a toolkit or set of guidelines for clinical use in primary care settings, which will be assessed for feasibility and acceptability in the latter phase of these projects.
To learn more about the Stimulant Use Disorder Projects, visit the OASIS website at: https://www.uclaisap.org/oasis-tta/html/projects/stimulant-use-disorder-project.html