Among Individuals Receiving Buprenorphine, Prescribed Stimulant Receipt Does Not Increase the Risk of Opioid-related Overdose

In the US and Canada, the percentage of deaths involving both unregulated fentanyl and stimulants has increased in recent years. Researchers in British Columbia used a database of individuals who experienced an opioid-related overdose from 2015 to 2020 to investigate the association between receiving a prescription stimulant medication and fatal and non-fatal overdose among those receiving opioid agonist therapy (OAT; i.e., buprenorphine, methadone, or slow-release morphine). The authors adjusted analyses for a number of potential confounders, including sociodemographic characteristics, substance use patterns, and mental health diagnoses.

• There were 9395 individuals who received OAT in the cohort; of these, 683 (7 percent) were prescribed a stimulant. A total of 1746 fatal and non-fatal overdose events occurred over the study period (9.6 per 100 person-years); 37 (2 percent) were fatal.
• Dispensation of a stimulant was not associated with an increased risk of overdose overall.
• Secondary analyses found that among individuals receiving buprenorphine, dispensation of a stimulant was associated with reduced risk of overdose (adjusted hazard ratio [aHR], 0.47), while those receiving full agonist OAT (methadone or morphine) had a greater risk of overdose (aHR, 1.51).

Comments: This study provides some reassurance that prescribing stimulants to individuals receiving buprenorphine does not appear to increase the risk of fatal and non-fatal overdose. The increased risk observed among those receiving full-agonist medications warrants further study.

Darius A. Rastegar, MD

Reference: Young S, Fairbairn N, Cui Z, t al. Association between prescribed stimulant medications and overdose among individuals receiving opioid agonist therapy: a retrospective cohort study from British Columbia, Canada. Addiction. 2025;120:1184–1194.