Correlates of cocaine use during methadone treatment: implications for screening and clinical management (ANRS Methaville study).

Perrine Roux,Alain Morel,Bruno Spire,Antoine Vilotitch,Patrizia M. Carrieri,Laurent Michel,Fabienne Marcellin,Gwenaelle Maradan,Marion Mora,Caroline Lions,The Anrs Methaville Study Group

doi:10.1186/s12954-016-0100-7

Abstract

BackgroundCocaine use is frequent in patients receiving methadone maintenance treatment (MMT) and can jeopardize their treatment response. Identifying clinical predictors of cocaine use during methadone treatment can potentially improve clinical management. We used longitudinal data from the ANRS Methaville trial both to describe self-reported occasional and regular cocaine use during MMT and to identify clinical predictors.MethodsWe selected 183 patients who had data on cocaine (or crack) use at months 0 (M0), M6, and/or M12, accounting for 483 visits. The outcome was “cocaine use” in three categories: “no,” “occasional,” and “regular” use. To identify factors associated with the outcome over time, we performed a mixed multinomial logistic regression.ResultsTime on methadone was significantly associated with a decrease in occasional but not in regular cocaine use from 14.7 % at M0 to 7.1 % at M12, and from 10.7 % at baseline to 6.5 % at M12, respectively. After multiple adjustments, opiate injection, individuals screening positive for attention deficit hyperactivity disorder (ADHD) symptoms, and those presenting depressive symptoms were more likely to regularly use cocaine.ConclusionsAlthough time on MMT had a positive impact on occasional cocaine use, it had no impact on regular cocaine use. Moreover, regular cocaine users were more likely to report opiate injection and to present ADHD and depressive symptoms. Early screening of these disorders and prompt tailored pharmacological and behavioral interventions can potentially reduce cocaine use and improve response to MMT.Trial registrationThe trial is registered with the French Agency of Pharmaceutical Products (AFSSAPS) under the number 2008-A0277-48, the European Union Drug Regulating Authorities Clinical Trials, number Eudract 2008-001338-28, the ClinicalTrials.gov Identifier: NCT00657397, and the International Standard Randomised Controlled Trial Number Register ISRCTN31125511.

Highlights

Cocaine use is frequent in patients receiving methadone maintenance treatment (MMT) and can jeopardize their treatment response
Studies on methadone-related mortality [13, 14] have shown that cocaine use while on Opioid maintenance treatment (OMT) is associated with a higher risk of overdose
Our results showed that cocaine use was highly prevalent among opioid-dependent individuals initiating methadone maintenance treatment, with almost one third of the sample reporting it at baseline

Summary

Introduction

Cocaine use is frequent in patients receiving methadone maintenance treatment (MMT) and can jeopardize their treatment response. We used longitudinal data from the ANRS Methaville trial both to describe self-reported occasional and regular cocaine use during MMT and to identify clinical predictors. Other studies highlight that people who continue to use cocaine while on OMT are more likely to have a poorer response to treatment, in terms of retention and abstinence from street-opioid use [10, 11], and may have a lower level of pharmacokinetic exposure to methadone, the consequence being a decreased effect of methadone [12]. As it is known that cocaine use during methadone treatment may be associated with premature discharge [16], it seems important to identify predictors of cocaine use, in order to improve clinical management of these patients. We used longitudinal data from the ANRS Methaville trial, which enrolled opioid-dependent individuals starting methadone maintenance, to describe the pattern of cocaine use during MMT and to identify clinical correlates It would seem more relevant to investigate correlates of cocaine use more thoroughly and to provide clinicians with indications as to how they can better manage MMT patients whose cocaine use is deemed “at-risk.” We used longitudinal data from the ANRS Methaville trial, which enrolled opioid-dependent individuals starting methadone maintenance, to describe the pattern of cocaine use during MMT and to identify clinical correlates

Methods

Results

Discussion

Conclusion