Abstract
BackgroundOver-standard methadone doses are generally needed in the treatment of heroin use disorder (HUD) patients that display concomitant high-severity psychopathological symptomatology. A flexible dosing regimen may lead to higher retention rates in dual disorder (DD), as we demonstrated in bipolar 1 HUD patients, leading to outcomes that are as satisfactory as those of HUD patients without high-severity psychopathological symptomatology.ObjectiveThis study aimed to compare the long-term outcomes of treatment-resistant chronic psychosis HUD patients (PSY-HUD) with those of peers without dual disorder (HUD).Methods85 HUD patients who also met the criteria for treatment resistance—25 of them affected by chronic psychosis and 60 without DD—were monitored prospectively for up to 8 years while continuing to receive enhanced methadone maintenance treatment.ResultsThe rates of endurance in the treatment of PSY-HUD patients were 36%, compared with 34% for HUD patients (p = 0.872). After 3 years of treatment, these rates tended to become progressively more stable. PSY-HUD patients showed better outcome results than HUD patients regarding CGI severity (p < 0.001) and DSM-IV-GAF (p < 0.001). No differences were found regarding good toxicological outcomes or the methadone dosages used to achieve stabilization. The time required to stabilize PSY-HUD patients was shorter (p = 0.034).ConclusionsAn enhanced methadone maintenance treatment seems to be equally effective in patients with PSY-HUD and those with HUD.
Highlights
Opioid Use Disorder patients show a high rate of psychiatric comorbidities during agonist opioid treatment (AOT) [1]
An enhanced methadone maintenance treatment seems to be effective in patients with PSYHUD and those with heroin use disorder (HUD)
PSY-HUD patients more frequently had education lasting less than 8 years, presented a lower level of social adjustment with a lower frequency of legal problems, and self-reported a lower severity of drug addiction history
Summary
Opioid Use Disorder patients show a high rate of psychiatric comorbidities (anxiety, depression, sleep disorders) during agonist opioid treatment (AOT) [1]. In patients with PSY-HUD, a therapeutic use of heroin cannot be excluded, at least, at the beginning of their clinical history. This kind of situation was not reported in the case of bipolar HUD patients [4]. Above-standard methadone doses are usually needed in the presence of high-severity psychopathological symptomatology characterized by somatization, depression, paranoid ideation and psychoticism [8]. Over-standard methadone doses are generally needed in the treatment of heroin use disorder (HUD) patients that display concomitant high-severity psychopathological symptomatology. A flexible dosing regimen may lead to higher retention rates in dual disorder (DD), as we demonstrated in bipolar 1 HUD patients, leading to outcomes that are as satisfactory as those of HUD patients without high-severity psychopathological symptomatology
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