The objective of this study was to assess craving and mood
related to opioid and cocaine use among asymptomatic hepatitis C virus (HCV)+
and HCV− methadone patients who have not started antiviral treatment.
In this 28-week prospective ecological momentary assessment
(EMA) study, 114 methadone-maintained, heroin- and cocaine-abusing individuals
reported from the field in real time on their mood, craving, exposure to
drug-use triggers, and drug use via handheld computers.
Sixty-one percent were HCV+; none were overtly symptomatic
or receiving HCV treatment. HCV status was not associated with age, sex, race,
or past-30-day or lifetime heroin or cocaine use. In event-contingent EMA
entries, HCV+ individuals more often attributed use to having been bored,
worried, or sad; feeling uncomfortable; or others being critical of them
compared with HCV− participants. In randomly prompted EMA entries, HCV+
participants reported significantly more exposure to drug-use triggers, including
handling ≥$10, seeing cocaine or heroin, seeing someone being offered/use
cocaine or heroin, being tempted to use cocaine, and wanting to see what would
happen if they used just a little cocaine or heroin.
HCV+ individuals experienced more negative moods and more
often cited these negative moods as causes for drug use. HCV+ individuals
reported greater exposure to environmental drug-use triggers, but they did not
more frequently cite these as causes for drug use. The EMA data reported here
suggest that HCV+ intravenous drug users may experience more labile mood and
more reactivity to mood than HCV− intravenous drug users. The reason for the
difference is not clear, but HCV status may be relevant to tailoring of
treatment.
Table 1
Baseline Demographics and Drug-Use Characteristics by HCV Status (N = 114)
| Category | HCV+ | HCV− | p |
|---|---|---|---|
| HCV status (n, %) | 69 (61%) | 45 (39%) | |
| Age, years (M ± SD) | 41.5 ± 8.3 | 39.8 ± 7.7 | .28 |
| Male (n, %) | 45 (65%) | 27 (60%) | .57 |
| Non-Caucasian (n, %) | 40 (58%) | 32 (71%) | .16 |
| Education (M ± SD) | 11.6 ± 1.5 | 12.1 ± 1.4 | .10 |
| Net income, 30 days (M ± SD) | $694 ± 1280 | $560 ± 813 | .53 |
| Heroin use, years (M ± SD) | 13.7 ± 8.8 | 13.7 ± 8.2 | .63 |
| Cocaine use, years (M ± SD) | 12.6 ± 9.0 | 10.0 ± 7.8 | .15 |
| Other opiate use, 30 days (M ± SD) | 0.1 ± 0.4 | 0.8 ± 2.1 | .03 |
| Money spent on drugs, 30 days (M ± SD) | $2,074.30 ± 1,332.00 | $1,612.40 ± 1,001.90 | .04 |
| Overdose (M ± SD) | 0.8 ± 2.1 | 0.1 ± 0.5 | .013 |
| Route of administration of heroin (n, %) | <.001 | ||
| Intranasal | 9 (13%) | 36 (80%) | |
| Intravenous | 60 (87%) | 9 (20%) | |
| Route of administration of cocaine (n, %) | <.001 | ||
| Intranasal | 1 (1%) | 8 (19%) | |
| Intravenous | 43 (62%) | 5 (11%) | |
| Smoking | 24 (35%) | 31 (55%) | |
| Drinking to intoxication, 30 days (M ± SD) | 0.1 ± 0.8 | 0.5 ± 1.5 | .12 |
| Current tobacco smoking (n, %) | 64 (93%) | 34 (76%) | <.02 |
Note. HIV prevalence was very low in HCV+ and HCV− groups.
Table 3
Reason for Drug Use in Event-Contingent Entries and Exposure to Mood-Related Cues in Random-Prompt Entries by HCV Status (Adjusted for Education)
| Mood Triggers | Event-Contingent Entries—It Happened Because … | Random-Prompt Entries—Within the Past Hour … | ||||||
|---|---|---|---|---|---|---|---|---|
| HCV+ (%, 95% CI) | HCV− (%, 95% CI) | F Value (df) | p | HCV+ (%, 95% CI) | HCV− (%, 95% CI) | F Value (df) | p | |
| Bored | 52% (46%, 57%) | 32% (26%, 39%) | F (1, 83) = 16.62 | .0002 | 14% (13%, 15%) | 9% (8%, 9.4%) | F (1, 111) = 67.5 | .002 |
| Felt others critical | 23% (19%, 28%) | 12% (8%, 17%) | F(1, 83) = 10.38 | .004 | 11% (10%, 12%) | 4% (3.8%, 4.6%) | F (1, 111) = 145,6 | .0002 |
| Frustrated | 38% (33%, 44%) | 34% (27%, 41%) | F (1, 83) = 0.96 | .37 | 16% (15%, 17%) | 10% (9%, 11%) | F (1, 111) = 81.1 | .0002 |
| Sad | 32% (27%, 38%) | 21% (15%, 27%) | F (1, 83) = 6.62 | .018 | 13% (12%, 14%) | 7% (6%, 8%) | F (1, 111) = 78.1 | .0002 |
| Worried | 42% (36%, 48%) | 28% (21%, 35%) | F (1, 83) = 8.48 | .008 | 17% (16%, 18%) | 9% (8%, 10%) | F (1, 111) = 112.0 | .0002 |
| Uncomfortable | 24% (19%, 29%) | 12% (8%, 18%) | F (1, 83) = 7.58 | .012 | 11% (10%, 12%) | 10% (9%, 11%) | F (1, 111) = 5.0 | .041 |
| Good mood and felt like celebrating | 21% (17%, 26%) | 11% (7%, 16%) | F (1, 83) = 8.71 | .007 | 6% (5%, 7%) | 3% (2.7%, 4%) | F (1, 111) = 49.8 | .002 |
Below: Cravings for heroin, cocaine, and tobacco, reported in randomly prompted EMA entries, had higher intensities in HCV+ participants than in HCV− participants. Model-adjusted means and SEM are from linear mixed models (SAS Proc Mixed). Error bars indicate SEM. Response anchors were 0 = NO!, 1 = no??, 2 = yes??, 3 = YES!! * p < .05.
Below: Mood ratings in randomly prompted EMA reports were more negative in HCV+ participants than in HCV− participants. Details are the same as those for Figure 1.
Table 4
Exposure to Drug Cues by HCV Status in Random-Prompt Entries
| Past-Hour Drug Trigger | HCV+ (%, 95% CI) | HCV− (%, 95% CI) | F Value (df) | p |
|---|---|---|---|---|
| Handled ≥$10 | 41% (39%, 42%) | 29% (28%, 31%) | F (1, 111) = 108.7 | .0002 |
| Saw cocaine | 6% (6%, 7%) | 4% (3.2%, 4.1%) | F (1, 111) = 54.51 | .0002 |
| Saw heroin | 3% (3%, 4%) | 2% (2%, 3%) | F (1, 111) = 8.99 | .006 |
| Offered cocaine | 5% (5%, 6%) | 3% (2.8%, 3.6%) | F (1, 111) = 43.83 | .0002 |
| Offered heroin | 3% (2%, 3%) | 2% (1.7%, 2.4%) | F (1, 111) = 6.21 | .021 |
| Saw cocaine use | 2% (1%, 2%) | 0.4% (0.3%, 0.5%) | F (1, 111) = 60.78 | .0002 |
| Saw heroin use | 1% (0.9%, 1.3%) | 0.3% (0.2%, 0.4%) | F (1, 111) = 38.17 | .002 |
| Tempted cocaine | 8% (7.8%, 9.1%) | 7% (6%, 8%) | F (1, 111) = 7.42 | .012 |
| Tempted heroin | 4% (3.8%, 4.8%) | 4% (3.2%, 4.2%) | F (1, 111) = 2.82 | .12 |
| Wanted see happen cocaine | 6% (5.8%, 6.9%) | 4% (3.3%, 4.4%) | F (1, 111) = 38.14 | .0002 |
| Wanted to see happen heroin | 3% (2.8%, 3.6%) | 2.5% (2%, 3%) | F (1, 111) = 4.02 | .065 |
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