Comorbid opioid use is undertreated among forensic patients with schizophrenia

Kristiina Kivimies,Eila Repo-Tiihonen,Jari Tiihonen,Hannu Kautiainen

doi:10.1186/s13011-018-0177-y

Abstract

BackgroundSubstance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder.MethodsThe study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively.ResultsOf the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1–28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3–32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p = 0.022).ConclusionsOpioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia.Trial registrationOur study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.

Highlights

Substance use disorders are associated with poorer clinical outcomes in patients with schizophrenia
Most of the studies concerning comorbid substance use disorder among patients with schizophrenia are focused on the assumed association between cannabis use and the development of schizophrenia, and less attention has been paid to other specific substances, opioids are the most prevalent drugs among drug users in the European Union [13]
15.6% (23/148) had a history of opioid use disorder documented in health care records, of whom and 8.7% (2/23) had received opioid replacement treatment (95% Cl:1.1–28.0).The corresponding proportion among patients with opioid use disorder using substance use disorder services was 30.4% (565/ 1860), (95%Cl: 28.3–32.5) (Table 2)

Summary

Introduction

Substance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. Schizophrenia is a severe mental disorder, which affects the individual’s way of thinking, feeling and behaving in many ways It is one of the leading causes of years lived with disability [1]. The prevalences are found to be lower in Europe than in the United States [5] These comorbidities are associated with poorer clinical outcomes but. Most of the studies concerning comorbid substance use disorder among patients with schizophrenia are focused on the assumed association between cannabis use and the development of schizophrenia, and less attention has been paid to other specific substances, opioids are the most prevalent drugs among drug users in the European Union [13].

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