Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicineReportar como inadecuado




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BMC Psychiatry

, 17:245

Substance-related disorders, addiction and impulse control

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.

KeywordsOpioid maintenance treatment Polydrug abuse Dose Drug screening Time-of-flight mass spectrometry AbbreviationsAlpha-PVPalpha-pyrrolidinovalerophenone

BZDBenzodiazepine

CYPCytochrome P450 enzyme

DSM-IVDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition

EMCDDAEuropean Monitoring Centre for Drugs and Drug Addiction

GC-MSGas chromatography – mass spectrometry

Group AOpioid-dependent patients in opioid maintenance treatment with adequate doses of the opioid maintenance treatment medicine as experienced by the patients

Group IAOpioid-dependent patients in opioid maintenance treatment with inadequate doses of the opioid maintenance treatment medicine as experienced by the patients

LC-TOFMSLiquid chromatography - high-resolution time-of-flight mass spectrometry

LOQLimit of quantification

MDMA3, 4- methylenedioxymethamphetamine ecstasy

MPAMethiopropamine

N-PPMNon - prescribed psychotropic medicines

NPSNew psychoactive substances

OMTOpioid maintenance treatment

OOWS scaleObjective Opiate Withdrawal Scale

PV8a-PHPP, alpha-pyrrolidinoheptiophenone

SDStandard deviation

SOWS scaleShort opiate withdrawal scale

THCTetrahydrocannabinol

THC-COOH11-nor-9-carboxy-tetrahydrocannabinol

UNDOCUnited Nations Office of Drugs and Crime

VASVisual analog scale

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Autor: Pertti Kalevi Heikman - Leea Hellevi Muhonen - Ilkka Antero Ojanperä

Fuente: https://link.springer.com/



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