Abstract
BackgroundConcomitant cocaine use is a major problem in clinical practice in methadone maintenance treatment (MMT) and may interfere with successful treatment. Data from European methadone populations is sparse. This register-based study sought to explore the association between prescribed methadone dose and concomitant cocaine and heroin use in the methadone population of Basel City.MethodsThe study included 613 methadone patients between April 1, 2003 and March 31, 2004. Anonymized data was taken from the methadone register of Basel City. For analysis of the prescribed methadone dose distribution, the patient sample was split into three methadone dosage groups: a low dose group (LDG) (n = 200; < 60 mg/day), a medium dose group (MDG) (n = 273; 60 to 100 mg/day), and a high dose group (HDG) (n = 140; > 100 mg/day). Concomitant drug use was based on self-report.ResultsAnalysis showed a significant difference in self-reported cocaine use between groups (p < 0.001). Patients in the LDG reported significantly fewer cocaine consumption days compared to the MDG (p < 0.001) and the HDG (p < 0.05). Patients in the HDG reported significantly fewer heroin consumption days than those in the LDG (p < 0.01) and the MDG (p < 0.001). In logistic regression analysis, cocaine use was significantly associated with heroin use (OR 4.9).ConclusionsCocaine use in methadone patients may be associated with heroin use, which indicates the importance of prescribing appropriate methadone dosages in order to indirectly reduce cocaine use.
Highlights
Opioid dependence is a serious chronic illness with a multitude of somatic and psychosocial risks and which in most cases requires long-term treatment [1,2,3,4]
Socio-demographic characteristics Of 613 methadone patients in maintenance treatment (MMT), 32.6% were in the low dose group (LDG) (n = 200), 44.5% in the medium dose group (MDG) (n = 273), and 22.8%
Demographic characteristics did not differ between the three methadone dosage groups, except for the variables employment status and age at first heroin use, with a significantly higher proportion of patients in the LDG than in the MDG and high dose group (HDG) who were employed or who had started using heroin significantly later in their lives
Summary
Opioid dependence is a serious chronic illness with a multitude of somatic and psychosocial risks and which in most cases requires long-term treatment [1,2,3,4]. Methadone maintenance treatment (MMT) is an effective treatment for opioid dependent patients, when given with other psychosocial services [1,2,3,4,5,6,7]. In Switzerland, the prevalence of opioid dependence was 0.9% in 2012 (men 1.6%, women 0.3%) [10] and cocaine has been used by approximately 4.1% of citizens aged between 15 and 64 years at least once in their lives [11]. Inclusion criteria for entering a MMT are opioid dependence, being at least 18 years of age, a positive toxicology test for heroin use, and failure in previous abstinence-oriented treatments. Data from European methadone populations is sparse
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