Concomitant drug abuse of opioid dependent patients in maintenance treatment detected with a multi‐target screening of oral fluid

Wagner, Elias; Raabe, Florian; Martin, Gabriele; Winter, Charles A.; Plörer, Diana; Krause, Daniela; Adorjan, Kristina; Koller, Gabriele; Pogarell, Oliver

doi:10.1111/ajad.12737

Cited by 17 publications

(9 citation statements)

References 23 publications

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“…2,6 Today, OMT is the most common and effective treatment for opioid dependence. 3,[7][8][9][10] To illustrate the effectiveness of OMT, Tran, Ohinmaa, Mills, et al 11 found that the proportion of self-reported opioid use among patients in OMT with continued opioid use decreased from 99.7% from baseline to 14.6% at 9-month follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…Several sources reported misuse of alcohol, benzodiazepines (BZD), amphetamines, cannabis, cocaine, and OMT medications. 7,10,[12][13][14] Synthetical opioids such as methadone, buprenorphine, and fentanyl are increasingly misused. 10 Frequent substance use and polydrug use in OMT is aproblem, 8,9,15 and such use is associated with dropout from OMT.…”

Section: Introductionmentioning

confidence: 99%

“…The magnitude of polydrug use among OMT patients has received little research attention. 7 A study showed that among OMT patients in Canada, 93.3% had used illicit substance, and 85% tested positive for polydrug use indicated by ≥ 2 illicit drug classes in the same test. 17 Soyka, et al 2 found that OMT patients in Germany increased use of alcohol, cannabis, and cocaine from baseline to 12 months, and at six-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

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<p>Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment</p>

Carlsen

Lunde

Torsheim

2020

SAR

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Purpose: Opioid maintenance treatment reduces a person's use of heroin. However, frequent substance use in treatment is a problem. Aim: To examine the association between opioid maintenance treatment and opioid/polydrug use, and whether social factors, adverse experiences, social resources, and quality of life are associated with opioid/polydrug use during the first 12 months in treatment. Patients and Methods: Forty-seven participants from treatment units in Bergen, Norway participated in five waves of data collection. Every third month, a structured face-to-face interview collected self-reported data on sociodemographic characteristics, opioid/polydrug use, participants' social resources or adverse experiences, and quality of life. Data were collected as part of KVARUS, the National Quality Register for Substance Abuse Treatment. A multilevel binary logistic regression analysis was conducted to examine the association of opioid/polydrug use and time in current treatment. The analysis included regressions of opioid/polydrug use on time-invariant baseline adverse experiences and social resources, and time-varying reports of quality of life. Results: There was a significant negative association between time in treatment and use of opioids, b =−0.89, SE = 0.19, p = <0.01. Furthermore, a negative association of age at substance use on polydrug use was found, b =−0.40, SE =0.19, p = 0.03. A higher overall quality of life was significantly associated with lower odds of opioid use during opioid maintenance treatment, b = −0.62, SE = 0.23, p = < 0.01. Social dimensions, participants' adverse experiences, and social resources were not associated with polydrug or opioid use. Conclusion: Opioid maintenance treatment is associated with lowered opioid use, but to a lesser degree with polydrug use. Our findings add quality of life as an important factor that should be given particular attention because it can offer insight to aspects that can affect the patients' opioid use.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment</p>

Carlsen

Lunde

Torsheim

2020

SAR

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“…Diğer maddelere ulaşamama, düşük maliyet, sosyalleşmenin artması, için gabapentinoidlerin daha sık kullanılmasına neden olur(15,16).İsveç'te bir opioid idame tedavisi kliniğinde, hastaların %21'i, en yaygın olarak duygusal sorunları gidermek için (%65) veya eğlence için (%27) ömür boyu tıbbi olmayan pregabalin kullandığını bildirdi(17). Benzer şekilde, opioid idame tedavisi alan hasta örnekleri arasında, İsrailli hastaların %17,7'si aktif reçete olmamasına rağmen pregabalin için pozitif test verirken(18), Almanya'da reçetesiz pregabalin ve gabapentin kullanımı hastaların sırasıyla %18,8 ve %1'inde tanımlandı(19). Bir kullandığını bildirdi.…”

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Opioid Kullanım Bozukluğu Olan Hastalarda Gabapentin ve Pregabalin Kullanım Sıklığı

Çiçek

DEMİREL

2022

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Amaç: Bu çalışmanın amacı AMATEM polikliniğine opioid kullanımı nedeniyle başvuran hastalarda gabapentin ve pregabalin kullanım sıklığının araştırılmasıdır. Yöntem: Çalışmaya halen opioid kullanan veya buprenorfin/ naloksan tedavisi alan 144 opioid kullanım bozukluğu olan hasta alındı.Yarı yapılandırılmış görüşme protokolü ile opioid ve gabapentinoid kullanımları değerlendirildi. Bulgular:Yaşam boyu gabapentin ve pregabalin kullanım sıklığı sırasıyla %51,4 ve %50,7 olarak bulundu. Polikliniğe başvurduğu sırada hastaların %35,4’ü gabapentin, %26,4’ü pregabalin kullanıyordu. Buprenorfin/naloksan kullanan hastaların %46’sının hem pregabalin hem de gabapentin kullandığı bulundu. Folyo ile opioid kullanan hastalar ile damardan kullanan hastalar arasında gabapentinoid kullanım sıklığı arasında herhangi bir fark bulunmadı. Sonuç: Opioid kullanım öyküsü olan hastaların gabapentinoid kötüye kullanımı için yüksek riskli bir grup oluşturduğu görülmektedir. Opioid kullanan hastaları takip eden hekimlerin kötüye kullanma riski olan hastalarda gabapentinoid reçete ederken dikkatli olmaları ve hastalara gabapentinoidlere alternatif ilaçlar önermeleri uygun olabilir.

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“…Concomitant drug abuse is a serious issue, especially among opioid-dependent patients in replacement therapy. 1 Clinical and epidemiological studies show that substance use disorders and psychiatric disorders are highly comorbid, 2 and psychiatric disorders are often accompanied by diverse medications, such as selective serotonin reuptake inhibitors and others. Due to drug interactions, substituted patients who use dextromethorphan are, therefore, exposed to a higher risk of developing (additional) psychiatric symptoms or serotonin syndrome, because high doses of dextromethorphan can result in hallucinations and mania.…”

mentioning

confidence: 99%

Dextromethorphan Abuse Among Opioid-Dependent Patients

Windhab

Gastberger²,

Hulka³

et al. 2020

Clin Neuropharm

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Background: Among opioid-dependent patients on maintenance therapy, concomitant drug abuse is a serious problem. Dextromethorphan, an over-the-counter antitussive agent that can be purchased without prescription, is a drug with a high potential for misuse, especially when consumed in high doses.The objective of this study was to investigate possible abuse of dextromethorphan among substituted opioid-dependent patients and comparison of subjective and objective findings.Due to its ability to increase serotonin levels, opioid-dependent patients may be particularly susceptible to dextromethorphan misuse. Dextromethorphan misuse may have side effects, including psychiatric symptoms and serotonin syndrome, and may induce assault, suicide, or homicide. Methods: A total of 104 opioiddependent patients in maintenance treatment were included in this cross-sectional study conducted in the outpatient department of the Psychiatric Hospital, University of Zurich. Study participants were divided into 2 groups based on laboratory results: dextromethorphan abusers (n = 12) and nonabusers (n = 92). The objective use and concentrations of dextromethorphan was detected using 3-month hair toxicology analysis.Statistical analysis was performed by using test, Student t test, Mann-Whitney U test, and Barnard exact test. Results: Dextromethorphan was abused by 12 (11.5%) patients, 11 (91.7%) of whom did not report concomitant abuse of dextromethorphan but were identified through hair analysis. In general, there were significant differences among patients abusing dextromethorphan compared with nondextromethorphan consumers in terms of trauma due to sexual maltreatment/violence, multiple traumas, or harmful use of hallucinogenic drugs. Conclusions: Further studies are necessary to examine dextromethorphan and its impact on patients with psychiatric comorbidities and psychiatric medication. According to literature, there is a significant drug interaction risk due to the impact of dextromethorphan misuse on serotonin syndrome and psychiatric symptoms. We recommend active inquiry into and testing for concomitant drug abuse among substituted opioid-dependent patients to reduce the risk of drug interactions and side effects in this especially vulnerable group of patients.

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Concomitant drug abuse of opioid dependent patients in maintenance treatment detected with a multi‐target screening of oral fluid

Abstract: Our study underscores the importance of monitoring a broad range of substances including others than usually screened in opioid-dependent patients in OMT. (Am J Addict 2018;XX:1-6).

Cited by 17 publications

References 23 publications

<p>Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment</p>

<p>Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment</p>

Opioid Kullanım Bozukluğu Olan Hastalarda Gabapentin ve Pregabalin Kullanım Sıklığı

Dextromethorphan Abuse Among Opioid-Dependent Patients

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