Stimulants and HIV: Addressing Contemporary and Recurring Epidemics (R61/R33 - Clinical Trial Required)

Stimulant use has been increasing among opioid users since 2016, based on overdose data and this makes control of the opioid epidemic more difficult, as it occurs in addition to the continuing influx of fentanyl and related compounds. Stimulant/opioid users present unfamiliar clinical issues to providers and experienced providers often find polysubstance users less motivated to address stimulant use. Stimulant use also has continued to account for a substantial fraction of HIV cases among gay men and other MSM. Much of this use is problematic/episodic (meth, cocaine, ketamine) and does not rise to the level of SUD or represents mild SUD despite problematic practices (syringe sharing, unprotected sex, etc.). We have limited tools for stimulant treatment and even fewer tools for addressing non-SUD or mild SUD stimulant use. New initiatives should incorporate new treatments as they become available. Particular attention is needed re: stimulant use in the context of polysubstance use that includes opioids including identification of motivations and contexts for more effectively implementing intervention.