Predictors of non-prescribed opioid use after one year of methadone treatment: An attributable-risk approach (ANRS-Methaville trial)

Lions, C.; Carrieri, Patrizia; Laurent, Michel; Mora, Marion; Marcellin, Fabienne; Morel, Alain; Spire, Bruno; Roux, Perrine

doi:10.1016/j.drugalcdep.2013.10.018

Cited by 30 publications

(12 citation statements)

References 44 publications

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“…Examples included past-12-month use of cannabis and cigarettes; peak number of alcoholic drinks in a day and number of drinks per drinking day; current alcohol use disorder and other substance use disorder. These findings differ from the treatment literature where the addition of opioid use has been associated with substantially worse outcomes (Lions et al, 2014; Sullivan et al, 2010). The 10.5% rate of past-12-month cocaine use among opioid users in the present study was also noticeably lower than in prior studies of treatment samples (Leri et al, 2003; Termorshuizen, Krol, Prins, Geskus, van den Brink, & van Ameijden, 2005; Williamson et al, 2007).…”

Section: Discussioncontrasting

confidence: 99%

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Leeman

Sun

Bogart

et al. 2016

Substance Use & Misuse

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Background Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally-representative sample involving primarily prescription opioid misuse would expand knowledge. Methods Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N=839). Cocaine-only, opioid-only and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric and medical conditions/events. Results Opioid-only users were the largest group (n=622), followed by cocaine-only (n=144) and co-users (n=73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment. Conclusions/Importance This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.

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Section: Discussioncontrasting

confidence: 99%

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Leeman

Sun

Bogart

et al. 2016

Substance Use & Misuse

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“…Possible response options included: no use, less than once a month, one to three times a month, approximately once a week, two to three times a week and ≥ daily. We chose to dichotomize cannabis exposure at ≥ daily versus < daily to be consistent with the measure employed in previous analyses of OAT outcomes , as well as because daily use might more probably reflect self‐medication use . Of note, measurements of cannabis use and involvement in OAT were asked in different parts of the interview.…”

Section: Methodsmentioning

confidence: 99%

High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

et al. 2018

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Background and Aims: Cannabis use is common among people on opioid agonist treatment (OAT), causing concern for some care providers. However, there is limited and conflicting evidence on the impact of cannabis use on OAT outcomes. Given the critical role of retention in OAT in reducing opioid-related morbidity and mortality, we aimed to estimate the association of at least daily cannabis use on the likelihood of retention in treatment among people initiating OAT. As a secondary aim we tested the impacts of less frequent cannabis use. Design: Data were drawn from two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Participants were followed for a median of 81 months (interquartile range: 37–130). Setting: Vancouver, Canada. Participants: 820 PWUD (58% men, 59% of Caucasian ethnicity, 32% HIV-positive) initiating OAT between December 1996 and May 2016. The proportion of women was higher among HIV-negative participants, with no other significant differences. Measurements: The primary outcome was retention in OAT, defined as remaining in OAT (methadone or buprenorphine/naloxone-based) for two consecutive six-month follow-up periods. The primary explanatory variable was cannabis use (at least daily versus less than daily) during the same six-month period. Confounders assessed included: socio-demographic characteristics, substance use patterns and social-structural exposures. Findings: In adjusted analysis, at least daily cannabis use was positively associated with retention in OAT (Adjusted Odds Ratio = 1.21, 95% Confidence Interval: 1.04–1.41). Our secondary analysis showed that compared with non-cannabis users, at least daily users had increased odds of retention in OAT (AOR = 1.20, 95% CI: 1.02 – 1.43), but not less than daily users (AOR = 1.00, 95% CI: 0.87 – 1.14). Conclusions: Among people who use illicit drugs initiating opioid agonist treatment in Vancouver, at least daily cannabis use was associated with approximately 21% greater odds of retention in treatment compared with less than daily consumption.

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“…In Ontario, Canada, the number of patients receiving MMT has nearly doubled since 2010 [12]. Despite its effectiveness, a significant number of patients respond poorly to treatment and experience relapse [14]. Illicit opioid use in combination with MMT is of immense concern, as it is a substantial risk factor for overdose and death [15].…”

Section: Introductionmentioning

confidence: 99%

Association between cannabis use and methadone maintenance treatment outcomes: an investigation into sex differences

et al. 2017

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BackgroundCannabis will soon become legalized in Canada, and it is currently unclear how this will impact public health. Methadone maintenance treatment (MMT) is the most common pharmacological treatment for opioid use disorder (OUD), and despite its documented effectiveness, a large number of patients respond poorly and experience relapse to illicit opioids. Some studies implicate cannabis use as a risk factor for poor MMT response. Although it is well established that substance-use behaviors differ by sex, few of these studies have considered sex as a potential moderator. The current study aims to investigate sex differences in the association between cannabis use and illicit opioid use in a cohort of MMT patients.MethodsThis multicentre study recruited participants on MMT for OUD from Canadian Addiction Treatment Centre sites in Ontario, Canada. Sex differences in the association between any cannabis use and illicit opioid use were investigated using multivariable logistic regression. A secondary analysis was conducted to investigate the association with heaviness of cannabis use.ResultsThe study included 414 men and 363 women with OUD receiving MMT. Cannabis use was significantly associated with illicit opioid use in women only (OR = 1.82, 95% CI 1.18, 2.82, p = 0.007). Heaviness of cannabis use was not associated with illicit opioid use in men or women.ConclusionsThis is the largest study to date examining the association between cannabis use and illicit opioid use. Cannabis use may be a sex-specific predictor of poor response to MMT, such that women are more likely to use illicit opioids if they also use cannabis during treatment. Women may show improved treatment outcomes if cannabis use is addressed during MMT.

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Predictors of non-prescribed opioid use after one year of methadone treatment: An attributable-risk approach (ANRS-Methaville trial)

Cited by 30 publications

References 44 publications

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

Association between cannabis use and methadone maintenance treatment outcomes: an investigation into sex differences

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