Comparison of urine results concerning co-consumption of illicit heroin and other drugs in heroin and methadone maintenance programs

Abstract

Urine samples of patients from a heroin maintenance program (HMP) and a methadone maintenance program (MMP) were chromatographically analyzed 1 month before and 6 and 12 months into treatment for the presence of classical markers of heroin use as well as for the presence of markers for illicit heroin abuse. Furthermore, the samples were immunochemically tested for cannabinoids, cocaine metabolites, amphetamine, methylendioxyamphetamines and benzodiazepines. A co-consumption of illicit heroin (HER) in the HMP was determined to be 50% but was significantly lower compared to the MMP with a co-use of 71%. The incidence was high because not only acetylcodeine (AC) as a very specific marker was considered but also other marker substances for illicit HER use. Amphetamines played only a minor part in both collectives, and the proportion of HER and methadone patients using cocaine was similar and decreased during treatment. Also, the benzodiazepine use decreased, and cannabis use was high in both collectives during treatment. Considering only the AC in the present study, a co-use of illicit HER in the HMP was similar to previous reports concerning HER-assisted treatment programs. If additional marker substances were examined, the suspicion of a co-use of illicit HER is markedly enhanced.

Impact of Cannabis Use during Stabilization on Methadone Maintenance Treatment

“…In a study comparing detection of substance use over the first year of heroin‐maintenance and MMT, similar but less dramatic decreases in cannabis use were observed among methadone‐maintained patients. Both heroin and methadone‐maintenance resulted in dramatic reduction of illicit opiate use despite common cannabis use . Although our group has demonstrated the decline in multiple types of illicit drug use with long‐term MMT in the past, the present findings were to our knowledge the first to specifically examine patterns of cannabis use over time during the critical early stages of MMT.…”

Cannabinoid and opioid interactions: Implications for opiate dependence and withdrawal

“…Among those on methadone maintenance, rates of cannabis-positive UDS fall from 63% at the start of treatment to 57.1% six months later, finally dropping to 48.5% at the one-year mark. Meanwhile those on heroin maintenance increase over the study period from 54.5% to 69.5% (Musshoff et al, 2009). …”

Dosis de metadona y su relación con calidad de vida, satisfacción, psicopatología, rendimiento cognitivo y consumo adicional de sustancias no prescritas

“…Podemos, pues, considerar que el 80% de la muestra no presenta un consumo continuado de heroína o se encuentra abstinente a esta droga. Este porcentaje es sensiblemente inferior al encontrado en otros estudios, aunque los diferentes métodos no permiten establecer un paralelismo completo (Keen, Oliver, Rowse y Mathers, 2003;Musshoff, Trafkowski, Lichtermann y Madea, 2010). Lo que sí se observa es que quienes reciben las mayores dosis presentan significativamente menos consumo de heroína que quienes recibían menos de 90 mg/día.…”