Correlates of Cocaine Use During Methadone Treatment: Implications for Screening & Clinical Management

BACKGROUND:

Cocaine use is frequent in patients receiving methadone maintenance treatment (MMT) and can jeopardize their treatment response. Identifying clinical predictors of cocaine use during methadone treatment can potentially improve clinical management. We used longitudinal data from the ANRS Methaville trial both to describe self-reported occasional and regular cocaine use during MMT and to identify clinical predictors.

METHODS:

We selected 183 patients who had data on cocaine (or crack) use at months 0 (M0), M6, and/or M12, accounting for 483 visits. The outcome was "cocaine use" in three categories: "no," "occasional," and "regular" use. To identify factors associated with the outcome over time, we performed a mixed multinomial logistic regression.

RESULTS:

Time on methadone was significantly associated with a decrease in occasional but not in regular cocaine use from 14.7 % at M0 to 7.1 % at M12, and from 10.7 % at baseline to 6.5 % at M12, respectively. After multiple adjustments, opiate injection, individuals screening positive for attention deficit hyperactivity disorder (ADHD) symptoms, and those presenting depressive symptoms were more likely to regularly use cocaine.

CONCLUSIONS:

Although time on MMT had a positive impact on occasional cocaine use, it had no impact on regular cocaine use. Moreover, regular cocaine users were more likely to report opiate injection and to present ADHD and depressive symptoms. Early screening of these disorders and prompt tailored pharmacological and behavioral interventions can potentially reduce cocaine use and improve response to MMT.

Below:  Cocaine use in methadone patients: M0, M6, and M12 visits

Full article at:  http://goo.gl/A4p5Dp

By:  Roux P1,2,3, Lions C4,5,6, Vilotitch A4,5,6, Michel L7,8,9, Mora M4,5,6, Maradan G4,5,6, Marcellin F4,5,6, Spire B4,5,6, Morel A10, Carrieri PM4,5,6; ANRS Methaville study group.

• 1INSERM, UMR_S 912, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), 27 bd Jean Moulin, 13385, Marseille, France. perrine.roux@inserm.fr.
• 2Aix Marseille Université, UMR_S 912, IRD, Marseille, France. perrine.roux@inserm.fr.
• 3ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France. perrine.roux@inserm.fr.
• 4INSERM, UMR_S 912, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), 27 bd Jean Moulin, 13385, Marseille, France.
• 5Aix Marseille Université, UMR_S 912, IRD, Marseille, France.
• 6ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
• 7INSERM, Research Unit 669, Paris, France.
• 8Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France.
• 9Centre Pierre Nicole, Paris, France.
• 10Oppelia, Paris, France. 
• Harm Reduct J. 2016 Apr 5;13(1):12. doi: 10.1186/s12954-016-0100-7

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health