Antidepressants abuse in subjects with opioid use disorders: A 10‐year study in the French OPPIDUM program

Abstract

Accumulating evidence shows that some antidepressants are abused for their psychostimulant effects, but the extent of antidepressants abuse is unknown in subjects with opioid use disorders (OUD). The objective of this work is to assess the prevalence of antidepressant abuse and its correlates in subjects with OUD. Subjects ≥18 year-old in an opiate maintenance treatment (OMT) program who reported using an antidepressant were selected from the OPPIDUM program from 2011 to 2020. The outcome was antidepressant abuse. Antidepressant abusers were identified as subjects reporting at least one of the following behaviors: "drug abuse," "concomitant use of alcohol," "illegal obtaining," and "dose higher than recommended in the Summary of Product Characteristics." Among the 83 040 observations of subjects ≥18 year-old in an OMT program included in the OPPIDUM program from 2011 to 2020, 2708 (3.3%) subjects reported using an antidepressant in monotherapy. Among them, there were 385 (14.2%) abusers. The proportion of abusers was the highest for amitriptyline (n = 31, 25.0%). In multivariate analysis, antidepressant abuse was positively associated with amitriptyline (OR 2.07, 95% CI [1.16, 3.73]; p = 0.015), unemployment (OR 1.52, 95% CI [1.16, 2.01]; p = 0.003), the use of intravenous route of administration (OR 1.77, 95% CI [1.12, 2.80]; p = 0.014), and the use of benzodiazepines (OR 1.53, 95% CI [1.21, 1.94]; p < 0.001). Clinicians should be aware of the risk of antidepressant abuse when prescribing in subjects with OUD, accounting for their heterogeneous pharmacological properties that may account for their abuse potential.

Postmortem toxicology findings from the Camden Opioid Research Initiative

“…Medications commonly used to treat depression and psychiatric conditions were detected in 12 (29%) of the cases, though it is unclear if the antidepressants were obtained from a physician as a measure of clinical care, as medical records were not available to the researchers of this study. Although antidepressants are subject to misuse by those with OUD, they also associate with increased retention to buprenorphine treatment for OUD [ 55 , 56 ]. However, there was little evidence that the decedents in our study were receiving medication-assisted treatment for OUD.…”

Systematic assessment of non‐medical use of prescription drugs using doctor‐shopping indicators: A nation‐wide, repeated cross‐sectional study

“…zolpidem and zopiclone) [2,3], gabapentinoids (e.g. pregabalin and gabapentin) [4,5], methylphenidate [6,7], anticholinergics [8,9], antihistamines [10] and antidepressants [11].…”