TY - JOUR
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Benzodiazepines/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Female
KW - Finland
KW - Humans
KW - Male
KW - Methadone/therapeutic use
KW - Middle Aged
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/drug therapy
KW - Psychotropic Drugs/therapeutic use
KW - Retrospective Studies
KW - Substance-Related Disorders/drug therapy
KW - Dose
KW - Drug screening
KW - opioid maintenance treatment
KW - polydrug abuse
KW - Time-of-flight mass spectrometry
AU - Pertti Kalevi Heikman
AU - Leea Hellevi Muhonen
AU - Ilkka Antero Ojanpera
A1 - 
AB - BACKGROUND: Polydrug 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. METHODS: This 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. RESULTS: Inadequate 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. CONCLUSIONS: Polydrug 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.
AD - University of Helsinki and Helsinki University Central Hospital, Psychiatry, P.O. Box 22, Valskarinkatu 12 A, FI-00014, Helsinki, Finland. pertti.heikman@helsinki.fi.; University of Helsinki and Helsinki University Central Hospital, Psychiatry, P.O. Box 22, Valskarinkatu 12 A, FI-00014, Helsinki, Finland.; University of Helsinki, Forensic Medicine, P.O. Box 40, Kytosuontie 11, FI-00014, Helsinki, Finland.; National Institute for Health and Welfare, Forensic Toxicology Unit, P.O. Box 30, Mannerheimintie 166, FI-00271, Helsinki, Finland.
BT - BMC psychiatry
C5 - Opioids & Substance Use
CP - 1
CY - England
DO - 10.1186/s12888-017-1415-y
IS - 1
JF - BMC psychiatry
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Polydrug 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. METHODS: This 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. RESULTS: Inadequate 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. CONCLUSIONS: Polydrug 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.
PP - England
PY - 2017
SN - 1471-244X; 1471-244X
SP - 245
T1 - Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine
T2 - BMC psychiatry
TI - Polydrug abuse among opioid maintenance treatment patients is related to inadequate dose of maintenance treatment medicine
U1 - Opioids & Substance Use
U2 - 28683783
U3 - 10.1186/s12888-017-1415-y
VL - 17
VO - 1471-244X; 1471-244X
Y1 - 2017
Y2 - Jul 6
ER -