Exposure, outcome, and covariates
depression, Depression, DSM-5
DISORDERS
The primary exposure of interest, stimulant use, was defined according to UDS positivity for MA, other amphetamines, or cocaine in clinical trial data. UDS were collected with an FDA-approved one-step temperature-sensitive test cup; a further validity check was performed using a commercially available adulterant test strip. Stimulants are detectable in urine for approximately 3 days to 1 week, depending on dose, route of administration, and type of stimulant [The outcome was time from randomization to MOUD initiation, defined as the date of first prescription of buprenorphine or injection of XR-NTX. Participants who did not initiate MOUD were censored on the last day of study participation.Demographics, use of other substances, housing status, and depression history from both clinical trial and target population data were included in analyses as covariates as well as in generalizability formulas. Some covariates were measured in different ways across datasets. “Heavy alcohol/benzodiazepine use” was defined as DSM-5 use disorders in the clinical trials and the NSDUH. In TEDS, heavy use was defined by the appearance of benzodiazepines or alcohol on the list of reasons for entering treatment. In the ROI, use of benzodiazepine or alcohol 15 or more days in the past month was classified as heavy use. Injection drug use was past 30 days in clinical trials, TEDS, and ROI, and the past year in NSDUH. Experience of recent homelessness was the past month in the CTN trials, past 6 months in the ROI, current in TEDS, and not measured in the NSDUH household survey. Depression history was not measured in TEDS or ROI. Some covariate data was missing in all sources: 6% of cases from the clinical trials contained missing data, 2% of NSDUH surveys, 9% of TEDS episodes, and 3% of ROI surveys. Missing covariate data were multiply imputed using chained equations [