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Additional drug use on methadone programmes – often cocaine rather than heroin

Published online by Cambridge University Press:  02 January 2018

Nicholas Seivewright
Affiliation:
The Fitzwilliam Centre, 143–145 Fitzwilliam Street, Sheffield S1 4JP, email: [email protected]
Liz Horsley
Affiliation:
Sheffield
Kelly Gadsby
Affiliation:
Sheffield
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Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2006

It was interesting to see the issue of whether dosage of methadone affected the use of additional drugs raised in the Bulletin most recently by Kernan & Scully (Psychiatric Bulletin, June 2006, 30, 234). Although many clinicians are reluctant to prescribe high doses of methadone, the evidence does seem clear that heroin use tends to decline as methadone increases.

This is a substitution approach, but patients on methadone programmes can develop as many problems from ongoing cocaine as from heroin use (notably financial and psychiatric problems). This appears to be widespread (Reference Gossop, Marsden and StewartGossop et al, 2002), and in two related investigations of our own patients undergoing opioid substitution (n=57 and n=72) cocaine was used by many of the 77% of patients showing some additional drug in their urine. Abstinence from substance use was related to female gender (χ2=0.62, d.f.=1, P<0.1), type of substitute medication (χ2=6.8, d.f.=2, P<0.05) and being longer in treatment (t=1.61, P<0.1), but for overall drug use the dosage of maintenance agent had no effect. For cocaine this was one of the weakest relationships (χ2=0.2, d.f.=1, P40.1).

Outcomes in maintenance treatment are usually related to limiting heroin use, and the fallback measure of increasing methadone to achieve this has been attractive. We believe that the frequent use of cocaine among this population will render methadone treatment much less straightforward, with more requirements for additional behavioural treatments (Reference Schottenfeld, Chawarski and PakesSchottenfeld et al, 2005).

References

Gossop, M., Marsden, J., Stewart, D., et al (2002) Changes in use of crack cocaine after drug misuse treatment: 4–5 year follow-up results from the NationalTreatment Outcome Research Study (NTORS). Drug and Alcohol Dependence, 66, 2128.CrossRefGoogle ScholarPubMed
Schottenfeld, R., Chawarski, M., Pakes, J., et al (2005) Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. American Journal of Psychiatry, 162, 340349.Google Scholar
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