Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

Abstract

Background and Objectives Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders as compared to individuals with other non-psychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD). Methods Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another non-psychotic psychiatric disorder were explored by logistic regression analysis. Results Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (OR=0.97, 95% CI 0.95,0.99, p=0.046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR=0.73, 95% CI 0.3,1.77, p=0.485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR=2.12, 95% CI 1.06,4.22, p=0.033), antipsychotics (OR=3.57, 95% CI 1.74,7.32, p=0.001), mood-stabilizers (OR=6.61, 95% CI 1.51,28.97, p=0.012), and benzodiazepines (OR=2.22, 95% CI 1.11,4.43, p=0.024). Discussion and Conclusions This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of co-prescription of sedating and QTc prolonging medications in this group may pose unique safety concerns.

Opioid Use Disorder Comorbidity in Individuals With Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis

“…Unfortunately, individuals with schizophrenia tend to receive reduced medical care and access to treatments, including comorbid OUD 33,34 . At the same time, when engaged in treatment for OUD with MAT, persons with schizophrenia generally respond favourably and remain in treatment 35 . Because of the significant heterogeneity and limitations among the 7 studies included in the systematic review, we cannot offer novel recommendations for individuals with OUD and comorbid schizophrenia.…”

“…33,34 At the same time, when engaged in treatment for OUD with MAT, persons with schizophrenia generally respond favourably and remain in treatment. 35 Because of the significant heterogeneity and limitations among the 7 studies included in the systematic review, we cannot offer novel recommendations for individuals with OUD and comorbid schizophrenia. At the same time, 21 At present, the recommended pharmacological treatment for OUD is opioid agonist therapy (OAT) with buprenorphine or methadone.…”

Co‐occurring opioid use disorder and serious mental illness: A selective literature review

“…Comparing individuals with an SMI alone versus those with co‐occurring OUD and SMI poorer outcomes including more severe psychiatric symptoms and higher rates of hospitalization and incarceration were seen among the OUD and SMI individuals (Lamont et al, 2020).…”

“…An emerging body of evidence suggests that MAT may not only improve substance use outcomes but may also improve mental health outcomes in individuals with co-occurring diagnosis. For example, a study investigating methadone maintenance treatment found that a diagnosis of a psychosis spectrum disorder was associated with fewer opioid-positive drug screens and comparable retention rates in the program compared to individuals suffering from an OUD but not psychosis spectrum disorder (Lamont et al, 2020). In the criminal justice system, adults with OUD and SMI who received MAT showed significant reductions in inpatient mental health treatment, inpatient substance abuse treatment, and improved adherence to psychotropic medications (Robertson et al, 2018).…”

Prevalence and correlates of suicide attempts in high-risk populations: a cross-sectional study among patients receiving opioid agonist therapy in Norway

“…Additionally, polysubstance use, including substances used alongside OAT opioids, is common among OAT patients, with a prevalence of up to 70 % in this population [24,25]. While OAT may protect against suicide [9,10], polysubstance use is often a substantial contributor to reduced quality of life, homelessness, greater psychological distress, poorer social functioning, and mental disorder comorbidities -such as major depressive symptoms and borderline personality disorder [24,[26][27][28][29][30][31]. This places OAT patients at a high lifetime risk of attempting suicide [22].…”