Comorbid opioid use is undertreated among forensic patients with schizophrenia

Abstract

BackgroundSubstance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder.MethodsThe study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively.ResultsOf the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1–28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3–32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p = 0.022).ConclusionsOpioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia.Trial registrationOur study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

“… 11 This may reflect a lack of willingness to participate in the study, inability to provide informed consent, or perhaps, undertreatment of OUD in patients with psychotic disorders. 42 The small number of participants in the psychotic disorder group also limited the statistical power available to detect group differences. Larger studies will be required in the future.…”

Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study

“…Despite the complexity, it is well known that OMT (using well-tested opioid agonists of defined quality, dosage, release form, effects) reduces the harm related to OUD in comparison with ongoing use of illicit drugs outside of treatment. 55 …”

“…Despite the complexity, it is well known that OMT (using well-tested opioid agonists of defined quality, dosage, release form, effects) reduces the harm related to OUD in comparison with ongoing use of illicit drugs outside of treatment. 55 In conclusion, we present a comparative international project initiative to study OMT in the Czech Republic, Norway and Denmark. Investigations will improve our knowledge of how national treatment systems evolve over time regarding patient flow and OMT participation and outcomes.…”

Substance Use Patterns and Schizophrenia Spectrum Disorders: A Retrospective Study of Inpatients at a Community Teaching Hospital

“…Several epidemiologic studies have shown that schizophrenia spectrum disorders (SSDs) contribute significantly to years lived with disability [1]. Additionally, substance use disorders (SUDs) have been reported to co-occur commonly among patients with SSD (a comorbidity also known as dual diagnosis), attracting notable attention over the past few decades [2][3][4][5]. For example, in one epidemiological study, 47% of patients with schizophrenia were reported to have a SUD [2].…”

“…Most patients with comorbid SSD and substance use are Substance Use Patterns in Patients With SSD J Clin Med Res. 2020;12 (12):803-808 young males and have been shown to have a higher risk for medication noncompliance, multiple hospitalizations, unstable housing and homelessness, human immunodeficiency virus (HIV) infection, suicide, and violent behavior [3]. Regarding specific substances, those who use alcohol are reported to have higher hospital admissions, higher severity of positive symptoms, higher rates of extrapyramidal side effects including tardive dyskinesia, and "relative neuroleptic refractoriness" [2].…”