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Lancia M, Gambelunghe A, Gili A, Bacci M, Aroni K, Gambelunghe C. Pregabalin Abuse in Combination With Other Drugs: Monitoring Among Methadone Patients. Front Psychiatry 2020; 10:1022. [PMID: 32116826 PMCID: PMC7026508 DOI: 10.3389/fpsyt.2019.01022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In recent years, there has been an increase in the non-medical use of psychoactive prescription drugs including pregabalin (PGB). Studies have shown that multiple drug users and patients in methadone treatment programs administered PGB at high dosages in order to achieve euphoria, reduce withdrawal symptoms, or potentiate the effects of methadone. For these reasons, accurate toxicological monitoring is required for these high-risk individuals. MATERIALS AND METHODS The present study investigated whether PGB could be detected in the hair samples of 250 patients with a history of opiate dependency, and under toxicological surveillance assess their compliance with methadone maintenance therapy. RESULTS Opiates were found in 54/250 of all hair samples, while cannabis was present in 74/250 patients, cocaine was detected in 21/250 patients, and benzodiazepines without prescription were identified in 49/250 patients. As expected, methadone was present in all 250 patients (100%). PGB without prescription was found in the hair samples of 35/250 patients (14%). Of these, 91.43% were male, 48.57% were <30 y old, and 45.71% were between ages 30 and 50 y. There were no apparent associations among PGB use, daily methadone dosage, and duration of methadone maintenance therapy. Psychiatric comorbidities were present in 25.71% of the patients abusing PGB. Anxiety (55.56%) and depression (33.33%) were the most prevalent psychiatric disorders. DISCUSSION Most of the patients taking PGB (57.14%) used other drugs (especially opiates) concurrently. The utility of hair analysis is explained by easy and rapid sample collection and the ability of the hair to reflect long-term drug use and incorporate drug metabolites. The findings of this study suggested that PGB has significant potential for abuse by high-risk populations such as opioid users and patients with dual diagnosis. These risks are particularly high in cases of poly-drug use and drug intake that are not in compliance with prescription guidelines.
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Affiliation(s)
- Massimo Lancia
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Occupational Medicine, Respiratory Diseases and Toxicology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessio Gili
- Hygiene and Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Mauro Bacci
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Kyriaki Aroni
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Cristiana Gambelunghe
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
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McBrien H, Luo C, Sanger N, Zielinski L, Bhatt M, Zhu XM, Marsh DC, Thabane L, Samaan Z. Cannabis use during methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis. CMAJ Open 2019; 7:E665-E673. [PMID: 31744904 PMCID: PMC7010349 DOI: 10.9778/cmajo.20190026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Rates of cannabis use among patients receiving methadone maintenance therapy are high, and cannabis use may be associated with outcomes of methadone maintenance therapy. We examined the effect of cannabis use on opioid use in patients receiving methadone maintenance therapy to test the hypothesis that cannabis use is associated with a reduction in opioid use. METHODS In this systematic review, we searched MEDLINE/PubMed, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global from inception to July 12, 2018. We summarized the effects of cannabis use on opioid use during methadone maintenance therapy and treatment retention. We conducted meta-analyses using a random effects model. RESULTS We included 23 studies in our review. We performed a meta-analysis of 6 studies, with a total number of participants of 3676, examining use of cannabis and opioids during methadone maintenance therapy. Owing to high heterogeneity, we described the studies qualitatively but provide the forest plots as supplemental material. The overall quality of evidence was very low, with a high risk of bias, owing to the nature of observational studies. INTERPRETATION We found no consensus among studies that cannabis use is associated with reduced opioid use or longer treatment retention when used during methadone maintenance therapy in patients with opioid use disorder. PROSPERO Registration: CRD42015029372.
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Affiliation(s)
- Heather McBrien
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Candice Luo
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Nitika Sanger
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Laura Zielinski
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Meha Bhatt
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Xi Ming Zhu
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - David C Marsh
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Lehana Thabane
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont
| | - Zainab Samaan
- Statistical Sciences Program (McBrien), University of Toronto, Toronto, Ont.; Michael G. DeGroote School of Medicine (Luo), Medical Sciences Graduate Program (Sanger), Neuroscience Graduate Program (Zielinski) and Health Research Methodology Graduate Program (Bhatt), McMaster University, Hamilton, Ont.; St. George's Hospital Medical School (Zhu), University of London, London, UK; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Biostatistics Unit (Thabane), Research Institute at St. Joes, St. Joseph's Healthcare Hamilton; Departments of Health Research Methods, Evidence and Impact (Thabane, Samaan) and Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.
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Christensen S, Buggisch P, Mauss S, Böker KHW, Müller T, Klinker H, Zimmermann T, Serfert Y, Weber B, Reimer J, Wedemeyer H. Alcohol and Cannabis Consumption Does Not Diminish Cure Rates in a Real-World Cohort of Chronic Hepatitis C Virus Infected Patients on Opioid Substitution Therapy-Data From the German Hepatitis C-Registry (DHC-R). Subst Abuse 2019; 13:1178221819835847. [PMID: 30944519 PMCID: PMC6440029 DOI: 10.1177/1178221819835847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The importance of alcohol and cannabis consumption for the effectiveness of treatment of chronic hepatitis C virus (HCV) infection with direct acting antivirals (DAAs) in people on opioid substitution therapy (OST) has not been investigated in detail. METHODS We investigated sustained virological response (SVR) rates and proportion of lost to follow-up (LTFU) between OST (n = 739) and non-OST patients (n = 7008) in the German Hepatitis C-Registry (Deutsches Hepatitis C-Register, DHC-R), which is a national multicenter prospective non-interventional real-world registry. Non-OST patients comprised patients with former/current drug use (non-OST/DU; n = 1500) and patients never consuming drugs (non-OST/NDU; n = 5508). FINDINGS SVR 12/24 rates (intention to treat [ITT]) in patients consuming no or less than 30 g/day (women) or 40 g/day (men) were significantly higher in non-OST/NDU (range 91%-92%) vs OST patients (range 83%-86%), mainly due to significantly higher LTFU rates in OST (range 11%-12%) compared with non-OST/NDU (range 2%-3%). In non-OST/NDU with high alcohol consumption of more than 30/40 g/day, SVR 12/24 rates (ITT) were lower (85%) but did not differ to OST (85%) with high alcohol consumption. No significant differences could be seen for SVR 12/24 in per-protocol (PP) analysis independent of alcohol consumption or amount of alcohol intake. Cannabis use did not significantly influence SVR 12/24 in ITT or PP or LTFU. CONCLUSIONS High SVR rates could be achieved in both OST and non-OST patients irrespective of alcohol or cannabis consumption. However, LTFU is more likely in patients with current or former drug use than in patients without drug history and in patients with high alcohol consumption but occurred mainly after end of antiviral treatment (EOT), leaving a high chance for HCV elimination in these patients.
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Affiliation(s)
| | - Peter Buggisch
- ifi-institute for interdisciplinary medicine, Hamburg, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | | | - Tobias Müller
- Department of Gastroenterology and Hepatology, Charité Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - Hartwig Klinker
- Division of Infectious Disease, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Tim Zimmermann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Bernd Weber
- Praxiszentrum Friedrichsplatz / Competence Center Addiction, Kassel, Germany
| | - Jens Reimer
- Gesundheit Nord - Bremen Hospital Group, Bremen, Germany
- Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Heiner Wedemeyer
- Leberstiftungs-GmbH Deutschland, Hannover, Germany
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Chen T, Zhong N, Du J, Li Z, Zhao Y, Sun H, Chen Z, Jiang H, Zhao M. Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China. Addiction 2019; 114:259-267. [PMID: 30276902 DOI: 10.1111/add.14451] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
AIMS To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. DESIGN In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. SETTING Four compulsory rehabilitation centres in Shanghai, China. PARTICIPANTS A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis. MEASUREMENTS The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model. FINDINGS Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81 months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06-2.51] and ASPU (HR = 2.10, 1.24-3.56) classes were positively associated with the risk of heroin relapse. CONCLUSION Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.
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Affiliation(s)
- Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhibin Li
- Jiading Mental Health Center, Shanghai, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiming Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhikang Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Socías ME, Wood E, Lake S, Nolan S, Fairbairn N, Hayashi K, Shulha HP, Liu S, Kerr T, Milloy MJ. High-intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis. Addiction 2018; 113:2250-2258. [PMID: 30238568 PMCID: PMC6226334 DOI: 10.1111/add.14398] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/23/2018] [Accepted: 07/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Cannabis use is common among people on opioid agonist treatment (OAT), causing concern for some care providers. However, there is limited and conflicting evidence on the impact of cannabis use on OAT outcomes. Given the critical role of retention in OAT in reducing opioid-related morbidity and mortality, we aimed to estimate the association of at least daily cannabis use on the likelihood of retention in treatment among people initiating OAT. As a secondary aim we tested the impacts of less frequent cannabis use. DESIGN Data were drawn from two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Participants were followed for a median of 81 months (interquartile range = 37-130). SETTING Vancouver, Canada. PARTICIPANTS This study comprised a total of 820 PWUD (57.8% men, 59.4% of Caucasian ethnicity, 32.2% HIV-positive) initiating OAT between December 1996 and May 2016. The proportion of women was higher among HIV-negative participants, with no other significant differences. MEASUREMENTS The primary outcome was retention in OAT, defined as remaining in OAT (methadone or buprenorphine/naloxone-based) for two consecutive 6-month follow-up periods. The primary explanatory variable was cannabis use (at least daily versus less than daily) during the same 6-month period. Confounders assessed included: socio-demographic characteristics, substance use patterns and social-structural exposures. FINDINGS In adjusted analysis, at least daily cannabis use was positively associated with retention in OAT [adjusted odds ratio (aOR) = 1.21, 95% confidence interval (CI) = 1.04-1.41]. Our secondary analysis showed that compared with non-cannabis users, at least daily users had increased odds of retention in OAT (aOR = 1.20, 95% CI = 1.02-1.43), but not less than daily users (aOR = 1.00, 95% CI = 0.87-1.14). CONCLUSIONS Among people who use illicit drugs initiating opioid agonist treatment in Vancouver, at least daily cannabis use was associated with approximately 21% greater odds of retention in treatment compared with less than daily consumption.
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Affiliation(s)
- M. Eugenia Socías
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Stephanie Lake
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, CANADA, V5A 1S6
| | - Hennady P Shulha
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
| | - Seagle Liu
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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Wang L, Min JE, Krebs E, Evans E, Huang D, Liu L, Hser YI, Nosyk B. Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:32-40. [PMID: 28888099 PMCID: PMC5681890 DOI: 10.1016/j.drugpo.2017.07.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polydrug use may challenge effective treatment for substance use disorders. We evaluate whether secondary substance use modifies the association between treatment and primary drug use among primary heroin, cocaine and methamphetamine (MA) users. METHODS Data were obtained from prospective cohort studies on people who use illicit drugs (PWUD) in California, USA. Using repeated monthly data on self-reported secondary substance use (heroin, cocaine, MA, alcohol or marijuana; ≥1day in a month), primary drug use (≥1day in a month), and treatment participation, collected via timeline follow-back, we fitted generalized linear mixed multiple regression models controlling for potential confounders to examine the interactions between treatment and secondary substance use on the odds of primary heroin, cocaine and MA use, respectively. RESULTS Included in our study were 587 primary heroin, 444 primary MA, and 501 primary cocaine users, with a median of 32.4, 13.3 and 18.9 years of follow-up, respectively. In the absence of secondary substance use, treatment was strongly associated with decreased odds of primary drug use (adjusted odds ratios (aORs): 0.25, 95% CI: 0.24, 0.27, 0.07 (0.06, 0.08), and 0.07 (0.07, 0.09)) for primary heroin, MA, and cocaine users, respectively. Secondary substance use of any kind moderated these associations (0.82 (0.78, 0.87), 0.25 (0.21, 0.30) and 0.53 (0.45, 0.61), respectively), and these findings were consistent for each type of secondary substance considered. Moreover, we observed different associations in terms of direction and magnitude between secondary substance use and primary drug use during off-treatment periods across substance types. CONCLUSION This study demonstrates secondary substance use moderates the temporal associations between treatment and primary drug use among primary heroin, MA and cocaine users. Disparate patterns of polydrug use require careful measurement and analysis to inform targeted treatment for polydrug users.
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Affiliation(s)
- Linwei Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Jeong Eun Min
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Elizabeth Evans
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA; Centre for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Health Service Research & Development, Greater Los Angeles Healthcare System, 1301 Wilshire Blvd (111G), Los Angeles, CA 90073, USA.
| | - David Huang
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA.
| | - Lei Liu
- Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL 60611, USA.
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA.
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Miller KL, Puet BL, Roberts A, Hild C, Carter J, Black DL. Urine drug testing results and paired oral fluid comparison from patients enrolled in long-term medication-assisted treatment in Tennessee. J Subst Abuse Treat 2017; 76:36-42. [DOI: 10.1016/j.jsat.2017.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 01/23/2023]
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Rosic T, Naji L, Bawor M, Dennis BB, Plater C, Marsh DC, Thabane L, Samaan Z. The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: a prospective cohort study. Neuropsychiatr Dis Treat 2017; 13:1399-1408. [PMID: 28579787 PMCID: PMC5449137 DOI: 10.2147/ndt.s129480] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE There is a significant interindividual variability in treatment outcomes in methadone maintenance treatment (MMT) for opioid use disorder (OUD). This prospective cohort study examines the impact of comorbid psychiatric disorders on continued illicit opioid use in patients receiving MMT for OUD. METHODS Data were collected from 935 patients receiving MMT in outpatient clinics between June 2011 and June 2015. Using linear regression analysis, we evaluated the impact of having a comorbid psychiatric disorder on continued illicit opioid use during MMT, adjusting for important confounders. The main outcome measure was percentage of opioid-positive urine screens for 6 months. We conducted a subgroup analysis to determine the influence of specific comorbid psychiatric disorders, including substance use disorders, on continued illicit opioid use. RESULTS Approximately 80% of participants had at least one comorbid psychiatric disorder in addition to OUD, and 42% of participants had a comorbid substance use disorder. There was no significant association between having a psychiatric comorbidity and continuing opioid use (P=0.248). Results from subgroup analysis, however, suggest that comorbid tranquilizer (β=20.781, P<0.001) and cocaine (β=6.344, P=0.031) use disorders are associated with increased rates of continuing opioid use. CONCLUSION Results from our study may serve to guide future MMT guidelines. Specifically, we find that cocaine or tranquilizer use disorder, comorbid with OUD, places patients at high risk for poor MMT outcomes. Treatment centers may choose to gear more intensive therapy toward such populations.
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Affiliation(s)
| | - Leen Naji
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Lehana Thabane
- Biostatistics Unit, Research Institute, St Joseph's Healthcare.,Department of Clinical Epidemiology and Biostatistics, McMaster University.,Peter Boris Centre for Addictions Research
| | - Zainab Samaan
- Biostatistics Unit, Research Institute, St Joseph's Healthcare.,Department of Clinical Epidemiology and Biostatistics, McMaster University.,Peter Boris Centre for Addictions Research.,Mood Disorders Research Unit, St Joseph's Healthcare.,Population Genomics Program, Chanchlani Research Centre.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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