Comorbid opioid use is undertreated among forensic patients with schizophrenia.

Publisher: BioMed Central Country of Publication: England NLM ID: 101258060 Publication Model: Electronic Cited Medium: Internet ISSN: 1747-597X (Electronic) Linking ISSN: 1747597X NLM ISO Abbreviation: Subst Abuse Treat Prev Policy Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Forensic Psychiatry/*statistics & numerical data ; Opiate Substitution Treatment/*statistics & numerical data ; Opioid-Related Disorders/*drug therapy ; Opioid-Related Disorders/*epidemiology ; Schizophrenia/*epidemiology; Adult ; Comorbidity ; Diagnosis, Dual (Psychiatry)/statistics & numerical data ; Female ; Finland/epidemiology ; Humans ; Male ; Registries ; Retrospective Studies ; Young Adult

Background: Substance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder.
Methods: The study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively.
Results: Of the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1-28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3-32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p = 0.022).
Conclusions: Opioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia.
Trial Registration: Our study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.

Schizophr Res. 2011 Aug;130(1-3):228-33. (PMID: 21592731)
J Dual Diagn. 2015;11(2):128-35. (PMID: 25781867)
Schizophr Bull. 2017 Jul 1;43(4):843-851. (PMID: 28199703)
Addict Behav. 2013 Jul;38(7):2313-6. (PMID: 23584191)
Expert Opin Pharmacother. 2016 Sep;17(13):1727-31. (PMID: 27376622)
Prog Neuropsychopharmacol Biol Psychiatry. 2006 Mar;30(2):265-72. (PMID: 16309810)
J Dual Diagn. 2014;10(1):52-7. (PMID: 25392062)
Drug Alcohol Depend. 2015 Nov 1;156:57-61. (PMID: 26455554)
Br J Psychiatry. 2006 Mar;188:237-42. (PMID: 16507965)
Lancet. 2013 Nov 9;382(9904):1564-74. (PMID: 23993281)
Eur Psychiatry. 1999 Nov;14(7):366-71. (PMID: 10683620)
Cochrane Database Syst Rev. 2014 Feb 06;(2):CD002207. (PMID: 24500948)
J Forensic Sci. 2012 Nov;57(6):1524-30. (PMID: 22845057)
Psychiatr Prax. 2003 May;30 Suppl 2:S121-4. (PMID: 14509056)
Lancet. 2013 Nov 9;382(9904):1575-86. (PMID: 23993280)
J Subst Abuse Treat. 2016 Oct;69:50-6. (PMID: 27568510)
Acta Psychiatr Scand. 2005 Mar;111(3):244-9. (PMID: 15701109)
World Psychiatry. 2014 Jun;13(2):153-60. (PMID: 24890068)
Cochrane Database Syst Rev. 2011 Oct 05;(10):CD004147. (PMID: 21975742)
Addict Health. 2009 Fall;1(2):69-72. (PMID: 24494086)
Psychiatry Res. 2016 May 30;239:301-7. (PMID: 27046394)
Arch Suicide Res. 2010;14(2):158-70. (PMID: 20455151)
Clin Neuropharmacol. 2007 May-Jun;30(3):127-35. (PMID: 17545747)
Addiction. 2012 Feb;107(2):393-9. (PMID: 21883606)
Schizophr Res. 2004 Apr 1;67(2-3):157-66. (PMID: 14984874)
Drug Alcohol Depend. 2012 Aug 1;124(3):307-10. (PMID: 22382045)
JAMA. 1990 Nov 21;264(19):2511-8. (PMID: 2232018)
J Subst Abuse Treat. 2018 Mar;86:17-25. (PMID: 29415846)
Am J Psychiatry. 1998 Feb;155(2):226-31. (PMID: 9464202)
Cochrane Database Syst Rev. 2009 Jul 08;(3):CD002209. (PMID: 19588333)
PLoS Med. 2009 Aug;6(8):e1000120. (PMID: 19668362)
Addict Behav Rep. 2017 Sep 23;6:106-111. (PMID: 29450244)
J Subst Abuse Treat. 2008 Jan;34(1):123-38. (PMID: 17574803)
Eur Arch Psychiatry Clin Neurosci. 2012 Oct;262(7):607-16. (PMID: 22427152)
J Addict Med. 2013 May-Jun;7(3):177-82. (PMID: 23519049)
Am J Drug Alcohol Abuse. 2000 Aug;26(3):343-53. (PMID: 10976661)
Eur Rev Med Pharmacol Sci. 2014;18(3):287-302. (PMID: 24563427)
BMJ. 2003 Feb 22;326(7386):442-4. (PMID: 12595388)
J Manag Care Spec Pharm. 2015 Oct;21(10):902-12. (PMID: 26402390)
Psychiatr Serv. 2000 Feb;51(2):216-22. (PMID: 10655006)
J Subst Abuse Treat. 2018 Apr;87:79-85. (PMID: 29433788)

Keywords: Forensic psychiatry; Opioid replacement treatment; Schizophrenia

Date Created: 20181108 Date Completed: 20190115 Latest Revision: 20240403

20250114

PMC6219173

10.1186/s13011-018-0177-y

30400965