Abstract
BackgroundPolydrug abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). However, improved laboratory diagnostics is required to reveal polydrug abuse in its current scope. Furthermore, there are few studies focusing on the relationship between polydrug abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the polydrug abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients. Craving for opioids and withdrawal symptoms were evaluated as indicators of the adequacy rating.MethodsThis is a retrospective register-based study of 60 OMT patients on either methadone or sublingual buprenorphine/naloxone medication, whose polydrug abuse was studied from urine samples by means of a comprehensive high-resolution mass spectrometry method.ResultsInadequate doses of the OMT medicines were associated with higher subjective withdrawal scores and craving for opioids. Six groups of abused substances (benzodiazepines, amphetamines, opioids, cannabis, new psychoactive substances, and non-prescribed psychotropic medicines) were found among OMT patients. Group IA patients showed significantly more abuse of benzodiazepines and amphetamines than the Group A patients. All the new psychoactive substances and most of the non-prescribed psychotropic medicines were detected from the Group IA patients. There was no difference in the doses of the OMT medicine between Groups IA and A patients.ConclusionsPolydrug abuse, detected by definitive laboratory methods, was widespread and more common among Group IA than Group A patients, emphasizing the requirement for individual OMT medicine dose adjustment.
Highlights
Polydrug abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT)
No dosage differences for the OMT medicines were evident between Groups IA and A
Polydrug abuse This study found widespread polydrug abuse among OMT patients as 65% of the urine samples tested positive for abused drugs via LC-TOFMS analysis (Table 4)
Summary
Polydrug abuse is a known problem among opioid-dependent patients receiving opioid maintenance treatment (OMT). There are few studies focusing on the relationship between polydrug abuse and adequacy of the dose of OMT medicine. This study aimed to evaluate the polydrug abuse among opioid-dependent patients receiving OMT with inadequate (Group IA) and adequate (Group A) doses of OMT medicine as experienced by the patients. Maintenance treatment for opioid dependence (OMT), either with methadone or buprenorphine-based medications, improves retention in the treatment and reduces abuse of illicit opioids [1]. Many OMT studies have targeted patients with heroin dependence and cocaine abuse [2, 3]. Polydrug abuse during OMT is a significant problem based on surveys [4, 5] and on studies relying on standard immunoassay screening [6]. The abuse of BZD among OMT patients is worldwide, with a reported prevalence of 45% in France and 70% in Germany [8], 51% in Israel [9], 47% in the USA [10], and 38% in Australia [11]
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