Pattern and prevalence of substance use and dependence in two districts of Union Territory of Jammu & Kashmir: Special focus on opioids

Psychiatric comorbidities and concurrent substance use among people who inject drugs: a single-centre hospital-based study

The management of people who inject drugs (PWID) is compounded by the presence of psychiatric comorbidities leading to frequent relapses and poor treatment outcomes. Early identification and treatment of psychiatric comorbidities should be included in the management to enhance treatment outcomes. The objective of this study was to estimate the prevalence of psychiatric comorbidities and concurrent substance use among opioid injectors. This hospital-based, cross-sectional study was conducted from March 2021 to August 2022. This study included opioid injectors of all ages and both sexes. The Mini International Neuropsychiatric Interview-7 (MINI-7) and WHO-ASSIST were used to determine psychiatric comorbidities and concurrent substance use, respectively. Both crude and adjusted odds ratios were calculated to assess associations among demographic variables, concurrent substance use and psychiatric comorbidities. Among the 328 opioid injectors, the overall prevalence of psychiatric comorbidities was 88.1%, with the majority (68.6%) having more than one comorbidity. The most common psychiatric comorbidities were panic disorder (41.2%), social anxiety disorder (40.5%), and antisocial personality disorder (39.3%). Concurrent use of alcoholic beverages doubled the risk of ASPD (odds ratio 2.14 (1.24-3.72)). Cocaine (odds ratio 2.36 (1.10-5.03)) and amphetamines (odds ratio 7.68 (2.21-26.65)) increased the risk of OCD. Daily heroin injections were negatively associated (odds ratio 0.18 (0.03-0.94)) with psychotic disorders. Younger age (adjusted odds ratio 0.20 (0.79-0.53)) and never married status (adjusted odds ratio 2.62 (1.06-6.47)) were the only significant variables in the regression analysis. In conclusion, opioid injectors had a higher prevalence of numerous psychiatric comorbidities. The most common comorbidity was anxiety disorders. Concurrent use of tobacco, cannabis, cocaine, inhalants, etc., greatly increased the risk of psychiatric comorbidities.

Changing Pattern of Opioid Users Attending an Opioid Agonist Treatment Clinic in North India

Objectives  Illicit opioid use is a major concern across the globe due to its adverse health consequences. Pharmacological intervention is regarded as the cornerstone of management of opioid dependence and the Opioid Agonist Treatment (OAT) is the most effective intervention for this chronic relapsing disorder. Since the pattern of use of illicit substances, like opioids, changes with the course of time, we studied the profile of patients registered in an OAT clinic of a tertiary care center in North India over last 8 years. Methods  Retrospective chart review of patients registered in the OAT clinic was done. Comparisons were made among two periods (2012-2015 and 2016-2019). Results  Total number of opioid dependent patients registered in OAT clinic has increased from 139 in 2012 to 2015 to 309 in 2016 to 2019. Mean age at the first use of opioids has reduced significantly from 20.2 (± 2.7) years in 2012 to 2015 to 18.3 (± 3.2) years in 2016 to 2019 ( p  = 0.02). Parenteral route continues to remain as the dominant mode of use of opioids, though it has increased from 80.6 to 99% of users. There has been increased use of heroin over these years (12.2% in 2012-2015 to 72.5% in 2016-19) with concomitant decrease of pentazocine use (69.1-17.5%), respectively. Conclusion  The changing demographic and opioid use pattern in the last couple of years among patients attending OAT clinic should alert the policy makers, so that an integrated approach is put into action for effective prevention and management of opioid use disorders.