Concomitant Heroin and Cocaine Use among Opioid-Dependent Patients during Methadone, Buprenorphine or Morphine Opioid Agonist Therapy

Gastberger, Salome; Baumgartner, Markus R.; Soyka, Michael; Quednow, Boris B.; Hulka, Lea M.; Herdener, Marcus; Seifritz, Erich; Mutschler, Jochen

doi:10.1159/000500542

Cited by 12 publications

(9 citation statements)

References 31 publications

(34 reference statements)

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“…The systematic review by Mattick et al [21] demonstrated the efficacy of buprenorphine maintenance treatment, with a lower retention rate than methadone but allowing a similar decrease in opiate consumption. Some recent data suggest that buprenorphine maintenance treatment is associated with reduced additional opiate couse comparing with methadone or slow-release morphine maintenance treatment [22]. In addition, buprenorphine has been shown to reduce heroin overdose [23,24], and some data suggest that the death rate is lower for patients maintained by buprenorphine compared to patients maintained by methadone [25,26].…”

Section: Discussionmentioning

confidence: 99%

Primary Care of Opioid use Disorder: The End of “the French Model”?

Dupouy¹,

Maumus-Robert²,

Mansiaux³

et al. 2020

Eur Addict Res

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Background: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a 'French model' facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. Objectives: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. Materials and Methods: Using data from the French National Health Insurance database, we conducted a yearly repeated crosssectional study (2009-2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. Results: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. Conclusions: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

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Section: Discussionmentioning

confidence: 99%

Primary Care of Opioid use Disorder: The End of “the French Model”?

Dupouy¹,

Maumus-Robert²,

Mansiaux³

et al. 2020

Eur Addict Res

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“…Hair samples were originally analyzed in the context of a study conducted in an outpatient setting at the Centre for Addictive Disorders of the Psychiatric Hospital, University of Zurich in 2014. 22,23 From that study, we analyzed in further detail a range of substances in 104 patients, including 76 male and 28 female participants, in opioid substitution therapy. All 104 patients were included in this cross-sectional study, including 12 with comorbid dextromethorphan use and 92 patients with no dextromethorphan use.…”

Section: Subjectsmentioning

confidence: 99%

“…Assuming an average growth rate of 1 cm/month, the hair segment represents the consumption behavior of the last 3 months before collection. 23 The analytical limits of the method enable the detection of very low concentration in the hair samples. However, strong cosmetic treatments like bleaching can degrade the incorporated substances.…”

Section: Hair Analysismentioning

confidence: 99%

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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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“…Medications for opioid use disorder (MOUD)—such as methadone, buprenorphine, or buprenorphine-naloxone—curb opioid cravings and decrease overdose events [ 4 ]. MOUD treatment programs have become a key public health strategy in combatting the opioid epidemic [ 5 , 6 ], particularly during the COVID-19 pandemic [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Characterizing the social support and functioning of a low-threshold medication for opioid use disorder treatment cohort at intake

et al. 2022

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Background Despite the growing morbidity and mortality rates associated with opioid use disorder, a large gap still exists between treatment need and capacity. Low-threshold clinics utilizing medication for opioid use disorder (MOUD) treatment can increase treatment access but are understudied, and little is known about how patient demographic characteristics are associated with their social support and functioning in these settings. Methods We used multivariate regression to estimate associations between demographic characteristics and self-reported social support or functioning indicators among patients receiving MOUD in a low-threshold clinic using several validated instruments administered at intake: Behavior and Symptom Identification Scale, Brief Pain Inventory, and Life Events Checklist for DSM-5. Patients initiating MOUD treatment between April 1 and December 31, 2017, with complete surveys were included (N=582). Results Patients were primarily male (62%), aged 34 or older (53%), non-Hispanic White (79%), separated or not married (86%), and unemployed (64%). Over 20% did not live in a house or apartment in the past month. Women were more likely to “get along” with people outside their family or in social situations and to identify their partner as their source of support. Women, non-White, and older patients were at higher risk of social functioning-disrupting events (physical/sexual assaults or experiencing chronic pain), while employment and housing were protective against exposure to these trauma-related events. However, employment and housing also decreased the odds of talking with others about substance use. The aforementioned results were obtained from multivariate logistic regression models and were significant to p<0.05. Conclusions Variation in support and functioning by demographic characteristics suggests that treatment facilities may benefit from adopting strategies that take baseline disparities in support and functioning into account.

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Concomitant Heroin and Cocaine Use among Opioid-Dependent Patients during Methadone, Buprenorphine or Morphine Opioid Agonist Therapy

Cited by 12 publications

References 31 publications

Primary Care of Opioid use Disorder: The End of “the French Model”?

Primary Care of Opioid use Disorder: The End of “the French Model”?

Dextromethorphan Abuse Among Opioid-Dependent Patients

Characterizing the social support and functioning of a low-threshold medication for opioid use disorder treatment cohort at intake

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