Evaluation of functional status among patients undergoing maintenance treatments for opioid use disorders

Abstract

Background Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients with pharmacological opioid maintenance treatments according to different socio-demographic characteristic, health and disabilities domains and sexual difficulties. Methods A total of 593 patients from the Andalusia community, 329 were undergoing methadone treatment and 264 were undergoing buprenorphine treatment. The patients were interviewed by socio-demographic and opioid-related variables, assessed by functioning, disability and health domains (WHODAS 2.0.) and for sexual problems (PRSexDQ-SALSEX). Results We found significant differences in the socio-demographic and the opioid-related variables as the onset of opioid use, being on previous maintenance programs, opioid intravenous use, the length of previous maintenance programs, polydrug use and elevated seroprevalence rates (HCV and HIV) between the methadone group and the buprenorphine group. Regarding health and disability domains there were differences in the Understanding and communication domain, Getting around domain, Participation in society domain and in the WHODAS 2.0. simple and complex score, favoring buprenorphine-treated patients. The methadone group referred elevated sexual impairments compared with the buprenorphine group. Opioid-related variables as seroprevalence rates, other previous lifetime maintenance program, the daily opioid dosage and the daily alcohol use are the most discriminative variables between both groups. Participation in society variables and sexual problems were the most important clinical variables in distinguishing the methadone group from the buprenorphine group regarding their functional status. Conclusions The methadone group showed higher prevalence in opioid dependence-related variables, elevated disabilities in participation in society activities and sexual problems compared with the buprenorphine group. This study shows the importance of carry out a functional evaluation in the healthcare follow-up, especially in those areas related with social activity and with sexual problems.

Sexual Dysfunctions in Patients Receiving Opioid Agonist Treatment and Heroin-Assisted Treatment Compared to Patients in Private Practice—Identifying Group Differences and Predictors

“…Studies comparing methadone and buprenorphine with regard to the occurrence of SDs in male and female patients have to date shown mixed results. Ruíz Ruíz et al found the prevalence of SDs to be higher in the methadone group ( 36 ), whereas other studies did not find beneficial effects of buprenorphine ( 56 ). Therefore, the recommendation of switching from methadone to buprenorphine in MMT patients with SDs is not unequivocally supported by literature.…”

“…It also raises the question whether substance-use related lifestyle factors or opioid agonists themselves play a large role in the emergence of SDs in this patient population. Regarding the latter, studies have repeatedly demonstrated that male patients in MMT suffer from SDs more often when compared to patients receiving treatment with buprenorphine ( 35 , 36 ). This suggests that methadone itself contributes partly to the occurrence of SDs in opioid-dependent men.…”

“…Additionally, differences on the extent to which OAT affects sexual functioning have been found. It has been repeatedly demonstrated that SDs occur less frequently in OAT with buprenorphine compared to MMT ( 34 – 36 ).…”