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Co-occurring amphetamine use and associated medical and psychiatric comorbidity among opioid-dependent adults: results from the clinical Trials Network

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      Abstract

      BackgroundIn response to the rising rate of treatment admissions related to illicit use of amphetamines (eg, methamphetamine), we examined the prevalence of amphetamine use among treatment-seeking, opioid-dependent adults, explored whether amphetamine users were as likely as nonamphetamine users to enroll in opioid-dependence treatment trials, and determined whether amphetamine users manifested greater levels of medical and psychiatric comorbidity than nonusers.MethodsThe sample included 1257 opioid-dependent adults screened for participation in three-multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN001-003), which studied the effectiveness of buprenorphine for opioid detoxification under varying treatment conditions. Patients were recruited from 23 addiction treatment programs across the US. Medical and psychiatric comorbidity were examined by past-month amphetamine use (current vs former) and route of administration. Five mutually exclusive groups were examined, ie, nonusers, current amphetamine injectors, current amphetamine noninjectors, former amphetamine injectors, and former amphetamine noninjectors.ResultsOf the sample (n = 1257), 22.3% had a history of regular amphetamine use. Of the 280 amphetamine users, 30.3% reported injection as their primary route. Amphetamine users were more likely than nonusers to be white and use more substances. Amphetamine users were as likely as nonusers to enroll in treatment trials. Bivariate analyses indicated elevated rates of psychiatric problems (depression, anxiety, hallucinations, cognitive impairment, violence, suicidal thoughts/attempts) and medical illnesses (dermatological, hepatic, cardiovascular, respiratory, neurological, seizure, allergy conditions) among amphetamine users. After adjusting for demographic variables and lifetime use of other substances: current amphetamine users and former injectors showed an increased likelihood of having medical illnesses and hospitalizations; current injectors had elevated odds of suicidal thoughts or attempts; current noninjectors exhibited elevated odds of anxiety, cognitive impairment, and violent behaviors; and former noninjectors had increased odds of depression.ConclusionTreatment-seeking, amphetamine-using, opioid-dependent adults manifest greater levels of medical and psychiatric morbidity than treatment-seeking, opioid-dependent adults who have not used amphetamines, indicating a greater need for intensive clinical management.

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        The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.
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          Major physical and psychological harms of methamphetamine use.

          The major physical and psychological health effects of methamphetamine use, and the factors associated with such harms. Comprehensive review. Physical harms reviewed included toxicity and mortality, cardiovascular/cerebrovascular pathology, dependence and blood-borne virus transmission. Psychological harms include methamphetamine psychosis, depression, suicide, anxiety and violent behaviours. While high-profile health consequences, such as psychosis, are given prominence in the public debate, the negative sequelae extend far beyond this. This is a drug class that causes serious heart disease, has serious dependence liability and high rates of suicidal behaviours. The current public image of methamphetamine does not portray adequately the extensive, and in many cases insidious, harms caused.
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            Author and article information

            Affiliations
            [1 ]Departments of Epidemiology and Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City, NY
            [2 ]Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC
            [3 ]Department of Psychiatry, School of Medicine, University of Pennsylvania and Treatment Research Institute, Philadelphia, PA
            [4 ]David Geffen School of Medicine, NPI/Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
            Author notes
            Correspondence: Daniel J Pilowsky, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA, Tel +1 212 304 6554, Fax +1 646 317 0013, Email dp14@ 123456columbia.edu
            Journal
            Subst Abuse Rehabil
            Subst Abuse Rehabil
            Substance Abuse and Rehabilitation
            Dove Medical Press
            1179-8467
            2011
            27 July 2011
            : 2
            : 133-144
            21886430
            3163455
            10.2147/SAR.S20895
            sar-2-133
            © 2011 Pilowsky et al, publisher and licensee Dove Medical Press Ltd

            This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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            Original Research

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