Prescription opioid abuse in patients presenting for methadone maintenance treatment

Brands, Bruna; Blake, Joan E.; Sproule, Beth; Gourlay, Douglas; Busto, Usoa E.

doi:10.1016/j.drugalcdep.2003.10.012

Cited by 169 publications

(160 citation statements)

References 32 publications

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“…2 Patients with a history of opioid use report high rates of experiencing pain [3][4][5] that is often severe and interferes with daily activities. [3][4][5][6][7][8] Indeed, a large percentage of patients with opioid dependence who receive opioid agonist treatment report that pain preceded any use of addictive substances, 3,6,[9][10][11] and that the primary reason for starting opioid use was to reduce pain. 9 Among buprenorphine patients, 36-48 % report chronic pain.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8] Indeed, a large percentage of patients with opioid dependence who receive opioid agonist treatment report that pain preceded any use of addictive substances, 3,6,[9][10][11] and that the primary reason for starting opioid use was to reduce pain. 9 Among buprenorphine patients, 36-48 % report chronic pain. [12][13][14] Thus, buprenorphine recipients report far higher rates of chronic pain than the 10 % prevalence estimated in the general US population by the World Health Organization.…”

Section: Introductionmentioning

confidence: 99%

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Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

et al. 2015

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“…4,5 Institutional sources estimate approximately 80,000 regular opioid users in Canada 6 with geographic differences in prevalence and trends. Although the "street" availability of prescription analgesic opioids such as hydromorphone and morphine has increased in recent years, 7,8 intravenous use of heroin prevails in Vancouver and Montreal. 5,[9][10][11] Injectors are exposed to life-threatening health risks such as drug overdoses, bloodborne viral infections, endocarditis, and others.…”

Section: Introductionmentioning

confidence: 99%

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

et al. 2008

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Standardized assessment instruments such as the European Addiction Severity Index and the Maudsley Addiction Profile were employed. A total of 251 individuals were randomized from Vancouver, BC (192, 76.5%), and Montreal, Quebec (59, 23.5%); 38.5% were female, the mean age was 39.7 years (SD:8.6), and participants had injected drugs for 16.5 years (SD:9.9), on average. In the prior month, heroin was used a mean of 26.5 days (SD:7.4) and cocaine 16 days (SD;12.6). Vancouver had significantly more patients residing in unstable housing (88.5 vs. 22%; pG0.001) and higher use of smoked crack cocaine (16.9 days vs. 2.3 days in the prior month; pG0.001), while a significantly higher proportion of Montreal participants reported needle sharing in the prior 6 months (25% vs. 3.7%; pG0.001). In many respects, the patient cohort was similar to the European trials; however, NAOMI had a higher proportion of female participants and participants residing in unstable housing. This study suggests that the NAOMI study successfully recruited participants with a profile indicated for HAT. It also raises concern about the high levels of crack cocaine use and social marginalization.

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“…A study of illicit opioid-dependent individuals attending a large Toronto MMT program reported that oxycodone (46.6%), codeine (45.5%), morphine (21.3%), and hydromorphone (17.4%) were the most prevalently used prescription opioid drugs. A sizeable proportion of the sampled individuals were exclusively dependent on prescription opioids and had never used heroin in their lives; many attributed their ongoing opioid use to a habit that was initiated through treatment received for pain (10).…”

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confidence: 99%

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

2006

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Clinical Implications • Illicit opioid use to a large extent manifests via the illicit use of prescription opioids and typically includes polysubstance use. • Physical and (or) mental health comorbidities are highly prevalent in illicit opioid user populations. • Morbidity and (or) mortality risks are often associated with social marginalization. Limitations • Little is known about the patterns and consequences of illicit opioid use in general populations. • Owing to the marginalized and illegal status of illicit opioid users, information is available only from selective populations with limited potential for generalizability of data. • The OPICAN study specifically builds largely on self-report and may be subject to bias. Objectives: To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). Method: We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n = 679) was collected in 2002. Results: Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime. Conclusions: Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.

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Prescription opioid abuse in patients presenting for methadone maintenance treatment

Cited by 169 publications

References 32 publications

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

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