The long-term outcomes of drug use by methadone maintenance patients

Abstract

The aim of the study is to predict long-term outcomes of methadone maintenance (MM), other than continued heroin use, on the basis of drug use occurring early in MM treatment. In previous research, the weak association of initial drug use during MM with measures of rehabilitation status may be due to the use of measures that do not differentiate trends in different types of drug use. In the present study, 222 patients who completed 6 months of MM were assessed at program intake, evaluated for opiates and cocaine in the first 6 months of treatment, and given a follow-up assessment 2 years after treatment entry. The intake status of the patients was assessed using the Addiction Severity Index. Opiate and cocaine use during the first 6 months of MM was assessed by urine toxicology. Outcomes were assessed using a structured interview and official criminal records at follow-up. Cluster analysis of urine toxicologies during treatment identified 3 trajectory classes of MM patients: (A) variably high levels of opiate use, but consistently low cocaine use; (B) low and diminishing opiate and cocaine use; and (C) consistently high cocaine use, with diminishing opiate use. In an 18-month period, after these trends were observed, Cluster C had significantly more criminal charges than Cluster B had (3 times as many), but not significantly more than those of Cluster A. Clusters A and B did not differ significantly in criminal charges. Regardless of cluster membership, subjects with increasing levels of cocaine use in the first 6 months of MM had more hospitalizations for drug and alcohol problems during the follow-up period than subjects without increasing levels of cocaine use had. The results provide evidence of negative sequelae of cocaine use during MM that underscore the importance of clinical efforts to reduce levels of cocaine and other nonopiate drug use by MM patients.

Polydrug abuse and personality disorders in a sample of substance-abusing inpatients

“…Among monodrug abusers, this rate was 27.5% of the patients, whereas this rate was almost doubled in polydrug abusers (50.9%). This result is consistent with reports of negative treatment outcomes for polydrug abusers (Bleich et al, 1999;Bovasso & Cacciola, 2003;Darke et al, 1992;DeMaria et al, 2000;Downey et al, 2000;Gossop et al, 2003;Rittmannsberger et al, 2000). Another variable significantly associated with polydrug abuse in our sample is an earlier age of onset for substance use.…”

“…Furthermore, many studies have identified polydrug abuse as a predictor of negative treatment outcome (Bleich et al, 1999;Bovasso & Cacciola, 2003;Darke, Hall, Ross, & Wodak, 1992;DeMaria, Sterling, & Weinstein, 2000;Downey, Helmus, & Schuster, 2000;Gossop, Marsden, Stewart, & Kidd, 2003;Rittmannsberger, Silberbauer, Lehner, & Ruschak, 2000). HIV risk exposure has also been studied as another associated negative outcome (Darke et al, 1992).…”

Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users

“…In addition, high levels of polydrug use have been reported among people who use illicit drugs (PWUD) in a wide variety of treatment and community settings internationally (Ball & Ross, 1991; Booth, Leukefeld, Falck, Wang, & Carlson, 2006; Byqvist, 2006; Darke & Hall, 1995; Ives & Ghelani, 2006; Leri, Bruneau, & Stewart, 2003; Leri et al, 2005). Compared to mono-drug use, polydrug use has been associated with greater psychopathology (Booth, et al, 2006; Medina & Shear, 2007; Sumnall, Wagstaff, & Cole, 2004); higher levels of risky health behaviors (Patterson, Semple, Zians, & Strathdee, 2005); decreased cognitive functioning (Dillon, Copeland, & Jansen, 2003); poorer treatment engagement (John, Kwiatkowski, & Booth, 2001) and treatment outcomes (Bovasso & Cacciola, 2003; DeMaria, Sterling, & Weinstein, 2000; Williamson, Darke, Ross, & Teesson, 2006b); and increased non-fatal overdoses as well as drug-related deaths (Coffin et al, 2003; Strang et al, 1999). …”

Patterns of use of other drugs among those with alcohol dependence: Associations with drinking behavior and psychopathology

“…In clinical settings, the use of multiple substances is associated with poorer treatment outcomes for disorders associated with illicit drugs such as heroin, cocaine, and methamphetamine (e.g., Bovasso and Cacciola, 2003; DeMaria et al, 2000; Downey et al, 2000; Williamson et al, 2006). Similar but less extensive data are available examining the negative impact of concurrent non-alcohol substance use on interventions for AD (Malcolm et al, 2006; Martin et al, 1996).…”