Abstract
Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear. To determine the prevalence of psychological symptoms in a cohort of individuals receiving medication-assisted treatment for OUD and explore their association with patient characteristics and outcomes in treatment. Data were collected from 2788 participants receiving ongoing treatment for OUD recruited in two Canadian prospective cohort studies. The Maudsley Addiction Profile psychological symptoms subscale was administered to all participants via face-to-face interviews. A subset of participants (n = 666) also received assessment for psychiatric disorders with the Mini International Neuropsychiatric Interview. We used linear regression analysis to explore factors associated with psychological symptom score. The mean psychological symptom score was 12.6/40 (s.d. = 9.2). Participants with psychiatric comorbidity had higher scores than those without (mean 16.8 v. 8.6, P<0.001) and 31% of those with psychiatric comorbidity reported suicidal ideation. Higher psychological symptom score was associated with female gender (B = 1.59, 95% CI 0.92-2.25, P<0.001), antidepressant prescription (B = 4.35, 95% CI 3.61-5.09, P<0.001), percentage of opioid-positive urine screens (B = 0.02, 95% CI 0.01-0.03, P<0.001), and use of non-opioid substances (B = 1.92, 95% CI 0.89-2.95, P<0.001). Marriage and employment were associated with lower psychological symptoms. Psychological symptoms are associated with treatment outcomes in this population and the prevalence of suicidal ideation is an area of concern. Our findings highlight the ongoing need to optimise integrated mental health and addictions services for patients with OUD.
Highlights
Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders
To further assess treatment outcome, we examined the percentage of Psychological symptoms, medication-assisted treatment and opioid-use disorder non-opioid-positive urine drug screens collected during the same period prior to study entry
We present data on demographic characteristics and psychological symptoms using descriptive statistics with continuous variables summarised as means and s.d. for normally distributed variables, and medians with interquartile range (IQR) for skewed data
Summary
Patients receiving treatment for opioid-use disorder (OUD) may experience psychological symptoms without meeting full criteria for psychiatric disorders. The impact of these symptoms on treatment outcomes is unclear. The rise in opioid-related deaths, increasing by more than 20% on average between 2011 and 2016, has been most pronounced in the USA, Canada, Sweden, Norway, Ireland, and England and Wales.[1] Medication-assisted treatment (MAT) for OUD, including methadone, a full opioid agonist and buprenorphine, a partial opioid agonist, have demonstrated benefits in the reduction of prescription and non-prescription opioid use;[2,3] not all patients have favourable outcomes in treatment.[4] Individuals with OUD have a high prevalence of comorbid psychiatric disorders including depression and anxiety.[5,6] These comorbidities have been associated with worse retention in treatment,[7] opioid use[5,6] and mortality.[8] Many patients may experience psychological symptoms that do not meet full diagnostic criteria for psychiatric disorders but may compromise well-being or impair function .[7]
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