Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis

Hassan, Ahmed; Howe, Aaron; Samokhvalov, Andriy V.; Foll, Bernard Le; George, Tony P.

doi:10.1111/ajad.12581

Cited by 21 publications

(10 citation statements)

References 46 publications

(112 reference statements)

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“…Offer medications for an OUD in the context of connection to long-term addiction, mental health, and primary care treatment, where careful monitoring and dose titration can occur. (18,28,31,39,44,121)…”

Section: Recommendation 21mentioning

confidence: 99%

Canadian Guidelines on Opioid Use Disorder Among Older Adults

et al. 2020

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BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

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Section: Recommendation 21mentioning

confidence: 99%

Canadian Guidelines on Opioid Use Disorder Among Older Adults

et al. 2020

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“…Although there are effective pharmacological and psychotherapeutic options to treat MDD, their efficaciousness is sometimes not well understood among persons with SUD (e.g., when administered concurrently with opioid agonist therapy medications such as methadone or buprenorphine) [ 10 ]. Moreover, some prescription drugs have been found to significantly increase harms (e.g., completed suicide) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Major depressive disorder and access to health services among people who use illicit drugs in Vancouver, Canada

Beaulieu

Milloy

et al. 2018

Subst Abuse Treat Prev Policy

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BackgroundPeople who use illicit drugs (PWUD) are commonly diagnosed with major depressive disorder (MDD). However, little is known about whether PWUD living with MDD experience additional barriers to accessing health services compared to those without MDD. We sought to identify whether MDD symptoms were associated with perceived barriers to accessing health services among people who use illicit drugs (PWUD) in Vancouver, Canada.MethodsData were collected through prospective cohorts of PWUD in Vancouver, Canada between 2005 and 2016. Using multiple logistic regression, we examined the relationship between MDD symptoms, defined as a Centre for Epidemiologic Studies Depression (CES-D) scale total score of ≥16, and barriers to access health services. We also used descriptive statistics to examine common barriers among participants who reported any barriers.ResultsAmong a total of 1529 PWUD, including 521 (34.1%) females, 415 (27.1%) reported barriers to accessing health services, and 956 (62.5%) reported MDD symptoms at baseline. In multiple logistic regression analyses, after adjusting for a range of potential confounders, MDD symptoms (adjusted odds ratio [AOR] = 1.40; 95% confidence interval [CI]: 1.03–1.92) were positively and significantly associated with barriers to accessing health services. Among those who reported MDD symptoms and barriers to access, commonly reported barriers included: long wait lists/times (38.1%); and treated poorly by health care professionals (30.0%).ConclusionThese findings show that the likelihood of experiencing barriers to accessing health services was higher among PWUD with MDD symptoms compared to their counterparts. Policies and interventions tailored to address these barriers are urgently needed for this subpopulation of PWUD.

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“…These findings suggest the importance of identifying and treating psychiatric disorders among heroin-dependent individuals, since the effective treatment of psychiatric co-morbidity potentially improves prognosis for heroin use disorder (Hasin et al, 2004;Hassan et al, 2017). However, there is no clear evidence to support the hypothesis that heroin use, per se, increases the risk of these psychiatric disorders through possible molecular and/or cellular pathways.…”

Section: Psychiatric Illnessmentioning

confidence: 99%

Chronic heroin use disorder and the brain: Current evidence and future implications

Tolomeo

Steele

Ekhtiari

et al. 2021

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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The incidence of chronic heroin use disorder, including overdose deaths, has reached epidemic proportions. Here we summarise and evaluate our knowledge of the relationship between chronic heroin use disorder and the brain through a narrative review. A broad range of areas was considered including causal mechanisms, cognitive and neurological consequences of chronic heroin use and novel neuroscience-based clinical interventions. Chronic heroin use is associated with limited or very limited evidence of impairments in memory, cognitive impulsivity, non-planning impulsivity, compulsivity and decision-making.Additionally, there is some evidence for certain neurological disorders being caused by chronic heroin use, including toxic leukoencephalopathy and neurodegeneration. However, there is insufficient evidence on whether these impairments and disorders recover after abstinence. Whilst there is a high prevalence of comorbid psychiatric disorders, there is no clear evidence that chronic heroin use per se causes depression, bipolar disorder, PTSD and/or psychosis. Despite the growing burden on society from heroin use, knowledge of the long-term effects of chronic heroin use disorder on the brain remains limited. Nevertheless, there is evidence for progress in neuroscience-based interventions being made in two areas: assessment (cognitive assessment and neuroimaging) and interventions (cognitive training/remediation and neuromodulation).Longitudinal studies are needed to unravel addiction and neurotoxic mechanisms and clarify the role of pre-existing psychiatric symptoms and cognitive impairments.

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Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis

Abstract: To date, psychotherapy has the most documented evidence for efficacy. TCAs appears effective but with more adverse effects than SSRIs. Further studies of OAT and adjunct antidepressant treatments for dual diagnosis patients are warranted. (Am J Addict 2017;26:551-563).

Cited by 21 publications

References 46 publications

Canadian Guidelines on Opioid Use Disorder Among Older Adults

Canadian Guidelines on Opioid Use Disorder Among Older Adults

Major depressive disorder and access to health services among people who use illicit drugs in Vancouver, Canada

Chronic heroin use disorder and the brain: Current evidence and future implications

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