Concurrent Amphetamine and Methamphetamine Use Among Clients of Opioid Maintenance Treatment Programs in Golestan, Iran

Abstract

Background: Concurrent use of stimulants during opioid maintenance treatments (OMTs) negatively impacts the treatment outcomes. Objectives: The aim of this study is to evaluate the prevalence and correlation of amphetamine and methamphetamine use among OMT clients in Golestan province-Northeast of Iran. Methods: In a cross-sectional study, 750 OMT clients were recruited through a two-stage cluster sampling. Face-to-face interviews were conducted to complete the study questionnaire. Urine samples were also taken to perform rapid drug testing for morphine, amphetamine, methamphetamine, tramadol, cannabis, and benzodiazepines. Survey analysis command in STATA was used to estimate the prevalence of drug use among the target population. Results: In this study, 8.1% (95% CI: 3.6 to 12.6) of the participants had positive urine sample for amphetamine or methamphetamine. Also, 41.8% (95% CI: 34.4 to 49.1) of the clients had positive samples for morphine. The urine positivity rate of morphine was significantly higher among those who had positive urine sample for amphetamines (68.3%; 95% CI: 51.7 to 84.9 versus 39.4% 95% CI: 31.3 to 47.6). In multivariate analysis, lifetime alcohol consumption (adjusted OR: 2.8, 95% CI 1.5 to 5.5) and history of imprisonment (adjusted OR: 2.2, 95% CI: 1.0 to 4.6) were associated with positive urine sample for amphetamines. Conclusions: Simultaneous use of amphetamines among clients of OMTs was considerable. It is recommended to regularly test all OMT clients for concurrent use of stimulants. This is particularly important for clients with past history of alcohol consumption or imprisonment.

Opioid agonist therapy uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

“…Although the observed pattern may be simply due to possible biases in selection of sample, it might also be due to the recent shift in substance use practices among PWID in Iran and the increase in poly-drug use involving nonopioids among PWID in Iran. Recent studies have shown that methamphetamine use has been increasing among PWID with opioid use disorder [20]. We also found that compared to PWID who used only opioids within the last month, those who used only non-opioids and those who used opioids and non-opioids simultaneously were less likely to have received OAT.…”

“…On the other hand, the use of methamphetamine in PWID reduces the effectiveness of OAT program and subsequently lower satisfaction of patients from OAT [22]. These issues are problematic in a way that treatment of PWID who use synthetic drugs has turned into a challenging issue within the last years [20,21]. In Iran, there are only a limited number of centers providing treatments for stimulant use disorder.…”

Opioid agonist therapy uptake among people who inject drugs: the findings of two consecutive bio-behavioral surveillance surveys in Iran

“…Although the observed pattern may be simply due to possible biases in selection of the participants, it might also be due to the recent shift in substance use practices among PWID in Iran and the increase in poly-drug use involving non-opioids among them. Recent studies have shown that methamphetamine use has been *P values are for comparison of prevalence between two rounds of surveys in 2010 and 2014 **Type of substance: non-opioids = Shishe, hashish/grass/cannabis, marijuana, ecstasy, cocaine, and methamphetamine/crystal; opioids = opium, opium sap, opium syrup, heroin, norchizak, tamchizak, buprenorphine, methadone, and crack increasing among PWID with opioid use disorder [20]. We also found that compared to PWID who used only opioids within the previous month, those who used only non-opioids and those who used opioids and non-opioids simultaneously, were less likely to have received OAT.…”

“…On the other hand, the use of methamphetamine in PWID reduces the effectiveness of OAT programs and subsequently leads to lower satisfaction of patients with OAT [22]. These issues are problematic in a way that treatment of PWID who use synthetic drugs has turned into a challenging issue within the last few years [20,21]. In Iran, there are only a limited number of centers providing treatments for stimulant use disorder.…”

An Epidemic Problem: A Commentary on Stimulant Use in Opioid Maintenance Treatment

“…Interestingly, the authors highlighted that positive urine specimens for morphine were significantly higher among those who had positive urine samples for amphetamines. Furthermore, lifetime alcohol use and imprisonment were associated with positive urine samples for amphetamines (1). Recently, at the research level, psychological treatments such as motivational interviewing, the Matrix model, and cognitive-behavioral therapy have been evaluated for stimulant users in OMTPs (5)(6)(7)(8)(9)(10).…”