Uptake and Retention on Prescribed Psychostimulants for Harm Reduction: A Canadian Cohort Study

Methamphetamine use is on the rise in North America and is a growing contributor to the ongoing overdose crisis. Prescription psychostimulants have been available for patients with stimulant use disorder through a provincial harm reduction policy in British Columbia, Canada, since 2020, however, there is little data to inform the uptake of and retention in this intervention in the real-world.

Data from 3 harmonised prospective cohorts of people who use drugs in Vancouver, Canada, were examined for information on uptake, prescribing patterns, and retention on prescribed psychostimulants provided for the purposes of harm reduction among people who use non-prescribed stimulants. We used a general estimating equations model to examine factors associated with their use.

Among 1005 participants interviewed between 2020 and 2022, 79 (7.9%) received at least one prescription for a psychostimulant as a harm reduction intervention. Daily methamphetamine use and being engaged in some form of addiction treatment were both associated with increased odds of receiving a prescription while later calendar year and age were associated with decreased odds (all P < .05). Dextroamphetamine was the most common prescription (70%), followed by methylphenidate (29%). Retention on prescribed psychostimulants was low with only 23% of those receiving a prescription still on the medication at 6-month follow-up.

We observed a low and declining uptake of psychostimulant prescriptions provided for harm reduction purposes during this period, along with poor retention in treatment. These results suggest that further research should investigate factors to improve uptake and engagement of this medication among people who use stimulants, including patient suitability and dosing patterns.