Top

BMC Psychiatry

Published in:

Open Access 01-12-2017 | Research article

Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine

Authors: Pertti Kalevi Heikman, Leea Hellevi Muhonen, Ilkka Antero Ojanperä

Published in: BMC Psychiatry | Issue 1/2017

Abstract

Background

Polydrug 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.

Methods

This 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.

Results

Inadequate 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.

Conclusions

Polydrug 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.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA): European Drug Report. Trends and developments. Luxembourg: Publications Office of the European Union. 2016. http://www.emcdda.europa.eu/edr2016. Accessed 9 Feb 2017.

Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev Feb. 2014;6(2):CD002207.

Faggiano F, Vigna-Taglianti F, Versino E, Lemma P. Methadone maintenance at different dosages for opioid dependence. Cochrane Database Syst Rev. 2003; doi: 10.1002/14651858.CD002208.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA):National report 2014: Finland, Drug Situation 2014. 2015. http://www.emcdda.europa.eu/publications/national-reports/finland-2014. Accessed 10 Feb 2017.

Pauly V, Lapeyre-Mestre M, Braunstein D, Rueter M, Thirion X, Jouanjus E, Micallef J. Detection of signals of abuse and dependence applying disproportionality analysis. Eur J Clin Pharmacol 2015; doi: 10.1007/s00228-014-1783-x.

Piralishvili G, Otiashvili D, Sikharulidze Z, Kamkadize G, Poole, S, Woody GE. Opioid Addicted Buprenorphine Injectors: Drug Use During and After 12-Weeks of Buprenorphine-Naloxone or Methadone in the Rebublic of Georgia. Journal of Substance Abuse Treatment. 2015; http://dx.doi.org/10.1016/j.jsat.2014.10.003

United Nations Office of Drugs and Crime (UNODC): World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7).https:://www.unodc.org/wdr2016/. Accessed 10 Feb 2017.

European Monitoring Centre for Drugs and Drug Addiction ( EMCDDA: Perspectives on drugs. The misuse of benzodiazipines among high-risk opioid users. 2015. http://www.emcdda.europa.eu/topics/pods/benzodiazepines.Accessed 10 Feb 2017.

Gelkopf M, Bleich A, Hayward R, Bodner G, Adelson M. Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic. Drug Alcohol Depend. 1999;55:63–8.CrossRefPubMed

10.

Chen KW, Berger CC, Forde DP, D’Adamo C, Weintraub E, Gandhi D. Benzodiazepine use and misuse among patients in a methadone program. BMC Psychiatry. 2011;doi:1471-244X/11/90.

11.

Deacon RM, Nielsen S, Leung S, Rivas G, Cubitt T, Monds LA, Ezard N, Larance B, Linzeris N. Alprazolam use and related harm among opioid substitution treatment clients-12 months follow up after regulatory rescheduling. Int J Drug Policy. 2016; doi:10.1016/j.drugpo.2016.06.006.

12.

Apelt SM, Scherbaum N, Gölz J, Backmund M, Soyka M. Safety, effectiveness and tolerance of buprenorphine-naloxone in the treatment of opioid dependence: results from a nationwide non-interventional study in routine care. Pharmacopsychiatry. 2013;doi: 10.1055/s-0032-1330033.

13.

White WL, Campbell MD, Spencer RD, Hoffman HA, Crissman BA, DuPont RL. Patterns of abstinence or continued drug use among methadone maintenance patients and their relation to treatment retention. J Psychoactive Drugs. 2014; doi: 10.1080/02791072.2014.901587.

14.

Sundström M, Pelander A, Angerer V, Hutter M, Kneisel S, Ojanperä I. A High-sensitivity ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry (UHPLC-HR-TOFMS) method for screening synthetic cannabinoids and other drugs of abuse in urine. Anal Bioanal Chem. 2013; doi: 10.1007/s00216-013-7272-8.

15.

Heikman P, Sundstrröm M, Pelander A, Ojanperä I. New psychoactive substances as part of polydrug abuse within opioid maintenance treatment revealed by comprehensive high-resolution mass spectrometric urine drug screening. Hum Psychopharmacol Clin Exp. 2016; doi: 10.1002/hup.2512.

16.

Sundström M, Pelander A, Simojoki K, Ojanperä I. Patterns of drug abuse among drug users with regular and irregular attendance for treatment as detected by comprehensive UHPLC-HR-TOF-MS. Drug Test Analysis. 2016; doi: 10.1002/dta.1818.

17.

Grosshans M, Lemenager T, Vollmert C, Kaemmerer N, Schreiner R, Mutschler J, Wagner X, Kiefer F, Hermann D. Pregabalin abuse among opiate addicted patients. Eur J Clin Pharmacol. 2013; doi: 10.1007/s00228-013-1578-5.

18.

Ojanperä IA, Heikman PK, Rasanen IJ. Urine analysis of 3,4-methylendioxypyrovalerone in opioid-dependent patients by gas chromatography-mass spectrometry. Ther Drug Monit. 2011; doi: 10.1097/FTD.0b013e318208b693.

19.

Strain EC, Bigelow GE, Liebson IA, Stitzer M. Moderate-vs high dose methadone in the treatment of opioid dependence. A randomized trial. JAMA. 1999;281:1000–5.CrossRefPubMed

20.

Johnson RE, Chutuape MA, Strain EC. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N Engl J Med. 2000; doi: 10.1056/NEJM200011023431802.

21.

D’Aunno T, Pollack HA, Frimpong JA, Wuchiett D. Evidence-based treatment for opioid disorders. A 23-year national study of methadone dose levels. J Subst Abuse Treat. 2014;doi:10.1016/j.jsat.2014.06.001.

22.

Kourounis G, Richards BDW, Kyprianou E, Symeonidou E, Malliori M-M, Samartzis L. Review. Opioid substitution therapy: lowering the treatment thresholds. Drug Alcohol Depend. 2016; doi: org/10.1016/j.drugalcdep.2015.12.021.

23.

Soyka M, Zingg C, Koller G, Kuefner H. Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study. Int J Neuropsychopharmacol. 2008; doi: 10.1017/S146114570700836X.

24.

Linzeris N, Nielsen S. Benzodiazepines, methadone and buprenorphine: interactions and clinical management. American J Addict. 2009; doi: 10.1111/j.1521-0391.2009.00007.x.

25.

Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012; doi: 10.1016/j.drugalcdep.2012.07.004.

26.

Heikman P, Ojanperä I. Inadequate dose of opioid-agonist medication is related to misuse of benzodiazepines. Addict Disord Their Treatment. 2009;8:145–53.CrossRef

27.

DSM IV American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fourth ed. Washington, DC: American Psychiatric Association; 1994.

28.

Gossop M. Brief report. The development of a short opiate withdrawal scale (SOWS). Addict Behav. 1990;15:487–90.CrossRefPubMed

29.

Handelsman L, Cochrane KJ, Aronson MJ, Ness R, Rubinstein KJ, Kanof PD. Two new rating scales for opiate withdrawal. Am J Drug Abuse. 1987;doi: 10.3109/00952998709001515.

30.

United Nations Office of Drugs and Crime ( UNODC). Early Warning Advisory on New Psychoactive Substances. 2016. https://www.unodc.org/LSS/Home/NPS. Accessed 10 Feb 2017.

31.

Griffiths RR, Johnson MW. Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds. J Clin Psychiatry. 2005;66(Suppl 9):31–41.PubMed

32.

Baumeister M, Vogel M, Dursteler-MacFarland KM, Gerhard U, Strasser J, Walter M, Wiesbeck GA, Petitjean SA. Association between methadone dose and concomitant cocaine use in methadone maintenance treatment: a register-based study. Subst Abuse Treat Prev Policy. 2014; doi: 10.1186/1747-597x-9-46.

33.

Kremer M, Salvat E, Muller A, Yalcin I, Barrot M. Antidepressants and gabapentinoids in neuropathic pain: mechanistic insights. Neuroscience. 2016; doi: org/10.1016/j.neuroscience.2016.06.057.

34.

McLarnon ME, Fulto HG, MacIsaac C, Barret SP. Characteristics of quetiapine misuse among clients of a community-based methadone maintenance program. J Clin Psychopharmacol. 2012; doi: 10.1097/JCP.0b013e3182670648.

35.

Uehlinger C, Crettol S, Chassot P, Brocard M, Koeb L, Brawand-Amey M, Eap CB. Increased (R)-methadone plasma concentrations by quetiapine in cytochrome P450s and ABCB1 genotypes patients. J Clin Psychopharmacol. 2007; doi: 10.1097/JCP.0b013e3180592ad2.

36.

Swortwood MJ, Ellefsen KN, Wohlfarth A, Diao X, Concheiro-Guisan M, Kronstrand R, Huestis MA. First metabolic profile of PV8, a novel synthetic cathinone, in human hepatocytes and urine by high-resolution mass spectrometry. Anal Bioanal Chem. 2016; doi: 10.1007/s00216-016-9599-4.

37.

Eap CB, Buclin T, Baumann P. Interindividual variability of the clinical pharmacokinetics of methadone: implications for the treatment of opioid dependence. Clin Pharmacokinet. 2002; doi: 10.2165/00003088-200241140-00003.

38.

Hallinan R, Crettol S, Agho K, Attia J, Besson J, Croquette-Krokar M, Hämmig R, Deglon J-J, Byrne A, Ray J, Somogyi AA, Eap CB. Cannabis and benzodiazepines as determinants of methadone trough plasma concentration variability in maintenance treatment: a transnational study. Eur J Clin Pharmacol. 2009; doi:10.1007/s00228-009-0706-8.

39.

Schifano F, Orsolini L, Papanti GD, Corkery JM. Special article. Novel psychoactive substances of interest for psychiatry. World Psychiatry. 2015;14:15–26.CrossRefPubMedPubMedCentral

40.

Rapeli P, Fabritius C, Kalska H, Alho H. Memory function in opioid-dependent patients treated with methadone or buprenorphine along with benzodiazepines. Longitudinal change in comparison to healthy individuals. Subst Abuse Treat Prev Policy. 2009; doi: 10.1186/1747-597x-4-6.

41.

Soyka M. Alcohol use disorders in opioid maintenance therapy: prevalence, clinical correlates and treatment. Eur Addict Res. 2015; doi: 10.1159/000363232.

42.

Preston KL, Jobes ML, Phillips KA, Epstein DH. Real-time assessment of alcohol drinking and drug use in opioid-dependent polydrug users. Behav Phamacol. 2016; doi: 10.1097/FBP.0000000000000250.

43.

Tiffany ST, Wray JM. The clinical significance of drug craving. Ann N Y Acad Sci. 2012; doi: 10.1111/j.1749-6632.2011.06298.x.

44.

Yen C-F, Lin H-C, Wang P-W, Ko C-H, Lee K-H, Hsu C-Y, Chung K-S, Wu H-C, Cheng C-P. Heroin craving and its correlations with clinical outcome indicators in people with heroin dependence receiving methadone maintenance treatment. Compr Psychiatry. 2016; doi: http://dx.doi.org/10.1016/j.comppsych.2015.10.001

45.

deWet C, Reed L, Glasper A, Moran P, Bearn J, Gossop M. Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome. Drug Alcohol Depend. 2004; doi: 10.1016/j.drugalcdep.2004.04.002.

46.

Brooner RK, Kidorf MS, King Van L, Peirce J, Neufeld K, Stoller K, Kolodner K. Managing Psychiatric comorbidity within versus outside of methadone treatment Settings. A randomized and controlled evaluation. Addiction. 2013; doi: 10.1111/add.12269.

47.

Abramsohn Y, Peles E, Potik D, Schreiber S, Adelson M. Sense of coherence as a stable predictor for methadone maintenance treatment (MMT) outcome. J Psychoactive Drugs. 2009; doi:10.1080/02791072.2009.10400535.

Title: Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine
Authors: Pertti Kalevi Heikman
Leea Hellevi Muhonen
Ilkka Antero Ojanperä
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-017-1415-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

A two-phase approach for the identification of refugees with priority need for mental health care in Lebanon: a validation study

Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms

Trends in the prescription of benzodiazepines for the elderly in Korea

Retinoids, anxiety and peripartum depressive symptoms among Chinese women: a prospective cohort study

Correct recognition and continuum belief of mental disorders in a nursing student population

Depression: point-prevalence and risk factors in a North Cyprus household adult cross-sectional study