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Additional drug use on methadone programmes — often cocaine rather than heroin

The Fitzwilliam Centre, 143–145 Fitzwilliam Street, Sheffield S1 4JP, email: alayna.maurer{at}sct.nhs.uk

Liz Horsley, Pre-registration House Officer

Sheffield

Kelly Gadsby, Medical Student

Sheffield

It was interesting to see the issue of whether dosage of methadone affected the use of additional drugs raised in the Bulletin most recently by Kernan & Scully (Psychiatric Bulletin, June 2006, 30, 234). Although many clinicians are reluctant to prescribe high doses of methadone, the evidence does seem clear that heroin use tends to decline as methadone increases.

This is a substitution approach, but patients on methadone programmes can develop as many problems from ongoing cocaine as from heroin use (notably financial and psychiatric problems). This appears to be widespread (Gossop et al, 2002), and in two related investigations of our own patients undergoing opioid substitution (n=57 and n=72) cocaine was used by many of the 77% of patients showing some additional drug in their urine. Abstinence from substance use was related to female gender (²=0.62, d.f.=1, P<0.1), type of substitute medication (²=6.8, d.f.=2, P<0.05) and being longer in treatment (t=1.61, P<0.1), but for overall drug use the dosage of maintenance agent had no effect. For cocaine this was one of the weakest relationships (²=0.2, d.f.=1, P40.1).

Outcomes in maintenance treatment are usually related to limiting heroin use, and the fallback measure of increasing methadone to achieve this has been attractive. We believe that the frequent use of cocaine among this population will render methadone treatment much less straightforward, with more requirements for additional behavioural treatments (Schottenfeld et al, 2005).

References

GOSSOP, M., MARSDEN, J., STEWART, D., et al (2002) Changes in use of crack cocaine after drug misuse treatment: 4–5 year follow-up results from the National Treatment Outcome Research Study (NTORS). Drug and Alcohol Dependence, 66, 21 –28.[CrossRef][Medline]

SCHOTTENFELD, R., CHAWARSKI, M., PAKES, J., et al (2005) Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. American Journal of Psychiatry, 162, 340 –349.[Abstract/Free Full Text]

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This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Seivewright, N. Articles by Gadsby, K. Search for Related Content PubMed Articles by Seivewright, N. Articles by Gadsby, K.