To date, patterns of buprenorphine and naltrexone use among individuals with OUD and cooccurring substance use disorders (SUD) has not been well-characterized in national samples in the US. While medication for OUD (MOUD) receipt is posited to be lower in people with polysubstance use, the comparative effectiveness of different MOUDs has not been thoroughly investigated in such individuals.5,6 In the case of buprenorphine, individuals with cooccurring SUDs have historically been deemed poor candidates for buprenorphine treatment, although recent efforts have challenged such an approach to treatment.7 In the case of naltrexone, opioid antagonists have garnered US Food and Drug Administration indications for both OUD and alcohol use disorder (AUD); however, the effectiveness of naltrexone in treating OUD in individuals with cooccurring SUD is not well studied, including potential protection against other drug-related adverse events. While studies have suggested that opioid antagonists, such as naltrexone, lessen reinforcing effects of multiple addictive substances, including from alcohol,8 opioids,9 stimulants,10,11 and sedatives,12 high treatment discontinuation rates associated with naltrexone in studies of individuals with OUD6 have raised questions about whether buprenorphine may hold similar
