Alcohol holding up methadone treatment
This review asked whether excessive drinking can get in the way of treating heroin addiction.
No current evidence supports the clinical requirement asking people to stop their medicines for opioid addiction if they want to enter alcohol treatment.
Although there is a lot of research behind effective strategies for the screening, diagnosis and management of an alcohol or opioid use disorder individually, less is known about how best to care for those who also use other drugs, especially since the usual treatments for opioid addiction may not be allowed in a setting of alcohol use treatment.
For example, some fellowship meetings discourage people from continuing their medication for opioid addiction (methadone). Or some residential treatment centres require people to be “drug free” upon enrolment, which includes not using their suboxone. For safety reasons, methadone clinics reduce the dose for patients who drink excessively.
This review summarizes existing research and characterizes the prevalence, clinical implications and management options for heavy drinking among people who also use other illicit drugs.
Drinking by people using agonist medications like methadone or suboxone for opioid use disorders is common and brings along many unwanted side effects. Over time, people die.
We don’t know how to treat people who have alcohol use disorder and who also use other drugs but asking them to come off their prescribed medications isn’t based on evidence.
Nolan, S., Klimas, J., & Wood, E. (2016). Alcohol use in opioid agonist treatment. Addiction Science & Clinical Practice, 11, 17. http://doi.org/10.1186/s13722-016-0065-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146864/
Primary care looks at drinking among persons on methadone treatment
How should primary care doctors ask their methadone patients about alcohol use?
We worked with 13 primary care doctors and divided them into two groups. We trained one group on how to ask about and advise on heavy drinking. We looked at whether trained and coached doctors managed patients who drank.
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| photocredit: methadoneaddiction.com |
Primary care can look at drinking among persons on methadone treatment and advise on risks of heavy drinking.
We found that the trained doctors asked about and advised on heavy drinking more often than the untrained doctors. Four patients in their care drank less alcohol three months later, compared to two patients of the untrained doctors. Some doctors were reluctant to use their new learning in the practice because it was too complicated.
A bigger and simpler study must prove the positive results of this modest study
Methadone helps people with opioid use disorders use less drugs, but it doesn’t stop them from drinking. About 30% of them drink in excess of the low-risk drinking limits. Drinking makes their treatment harder and their health worse. Primary care doctors who prescribe methadone see patients weekly and can help them drink less.
Reference: Henihan, AM., McCombe, G., Klimas, J., Swan, D., Leahy, D….Cullen, W. (2016) Feasibility of Alcohol Screening among Patients receiving Opioid Agonist Treatment in Primary Care. BMC Family Practice, 17:153
What do persons on methadone in primary care think about alcohol screening?
Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care
New Paper Out Now
Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.
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| photocredit: emerald |
Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.
Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.
Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat
See also my previous posts about the PINTA study:
New paper out now: Psychosocial Interventions for Alcohol use among problem drug users
2014
Beg, steel or borrow: getting physicians to recruit patients in clinical trials
Addiction Medicine Education for Healthcare Improvement Initiatives: New Paper out Now
2013
Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland
Fidelity questions
Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project
Hepatitis C unchanged, but drinking soared
What is the study about?
– We wanted to find out how many people receiving treatment for opioid addiction (methadone) have Hepatitis C and other blood borne viruses
– And whether anything changed between the years 2006 and 2013
QUICK FACT:
Over a third of people who receive methadone in primary care and who drink excessively test positive for Hepatitis C
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| asam.org |
How was the study done?
– In 2013, we have done a secondary analysis of data collected during a feasibility study of an alcohol brief intervention for people attending primary care for methadone treatment
– We looked at two studies done in 2006 and 2013 and compared them
What did the study find?
– We found the proportion of patients with problem alcohol use was much higher (46% v 35%) in 2013.
– 37% of people who had Hepatitis C also drank excessively
In 2013, number of people who had Hepatitis C was not different from 2006, but more people drank excessively.
Why is the study important?
– Many people who receive treatment for opioid addiction have Hepatitis C
– Treatment of Hepatitis C is expensive
– Because heavy drinking can make the treatment even more expensive, we should help people drink less
Reference: Improvements in HCV-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention. Journal of Addiction Medicine: September/October 2016 – Volume 10 – Issue 5 – p 363–364
(http://journals.lww.com/journaladdictionmedicine/Citation/2016/10000/Commentary_on_Zeremski_et_al___2016___.11.aspx)
Alcohol Use among Persons on Methadone Treatment
NEW PAPER OUT NOW
Limited evidence that alcohol causes mortality among persons on methadone treatment
What is the study about?
· We wanted to find out whether alcohol causes deaths among persons on methadone treatment
QUICK FACT:
Current evidence is mixed about the negative impact of alcohol on deaths among persons on methadone treatment.
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| photocredit: addictiondisorders |
How was the study done?
· We looked at how, how many, and what types of people in methadone treatment in the Vancouver Injection Drug Users Study (VIDUS) died because of alcohol.
What did the study find?
140 (of the 1139 included) participants died during follow-up, and 21 died due to overdose
85 reported heavy drinking at baseline
heavy drinking and mortality were not related, regardless of whether they were on methadone treatment
85 reported heavy drinking at baseline
heavy drinking and mortality were not related, regardless of whether they were on methadone treatment
Alcohol could possibly contribute to deaths among persons on methadone treatment but it did not so in this study.
Why is the study important?
• Methadone is effective in treating heroin addiction, but many people taking it also drink excessively. One common complication in this treatment is hepatitis C infection. Together with alcohol, it affects liver negatively
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Reference: Klimas, J., Dong, H., Dobrer, S., Milloy, M-J, Kerr, T., Wood, E., Hayashi, K. (2016) Alcohol Use among Persons on Methadone Treatment. Addictive Disorders& Their Treatment In Press
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