Uso de reducción de daños y gravedad psicopatológica y médica en pacientes en programa de mantenimiento con metadona

  1. Nieves Martínez-Luna 1
  2. Laia Rodríguez-Cintas 2
  3. Abderraman Esojo 1
  4. Raúl Felipe Palma-Álvarez 1
  5. María Robles-Martínez 1
  6. Lara Grau-López 1
  7. Marta Perea 1
  8. Carlos Roncero 1
  1. 1 Servicio de Psiquiatría Hospital Universitario Vall d’Hebrón
  2. 2 Departamento de Psiquiatría. Universidad Autónoma de Barcelona
Revista:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Any de publicació: 2018

Volum: 30

Número: 3

Pàgines: 197-207

Tipus: Article

DOI: 10.20882/ADICCIONES.897 DIALNET GOOGLE SCHOLAR lock_openAccés obert editor

Altres publicacions en: Adicciones: Revista de socidrogalcohol

Resum

Methadone maintenance programs (MMP) for opioid dependence treatment have been widely used due to their effective therapeutic outcomes. Harm reduction programs (HRP) are complementary programs for severe patients with high risk behaviors and when abstinence is not possible. This study aims to compare patients in MMP that use HRP (MMP-HRP) and patients in MMP who do not use HRP (MMP-NO HRP). The sample was composed of 143 patients (MMP-HRP = 42 vs. MMP-NO HRP = 101). An additional subanalysis was performed with patients under 45 years of age (n = 116; MMP-HRP = 38 vs. MMP-NO HRP = 78). All patients were assessed with an ad hoc socio-demographic questionnaire, EuropASI, SCID-I, and SCID-II. Results show that MMP-HRP patients were younger with more frequent use of intravenous drugs and with a high prevalence of Cluster B personality disorders. MMP-NO HRP patients had lower methadone doses compared to MMP-HRP patients and preferred to use drugs by smoked route more frequently. In the subanalysis of patients under 45, MMP-HRP patients were younger, had a higher prevalence of liver diseases, more intravenous drug use, greater severity on the drug use scale, less social and family support in the suescales of EUROP-ASI than compared to patients under 45 years in the group MMP-NO HRP. In conclusion, MMP-HRP patients are younger compared to MMP-NO HRP patients, they also receive higher doses of methadone and had more intravenous use. The above findings imply that the early onset of high risk drug use and long-term exposure to heroin have more severe outcomes such as higher comorbidities (e.g. infectious diseases, medical and psychiatric disorders), and consequently, these patients are a more vulnerable group with a worse prognosis.

Referències bibliogràfiques

  • Amato, L., Davoli, M., Perucci, C. A., Ferri, M., Faggiano, F. y Mattick, R. P. (2005). An over view of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment, 28, 321– 329. doi:10.1016/j.jsat.2005.02.007.
  • Astals, M., Díaz, L., Domingo-Salvany, A., Martín-Santos, R., Bulbena, A. y Torrens, M. (2009). Impact of co-occurring psychiatric disorders on retention in a methadone maintenance program: an 18-month follow-up study. International Journal of Environmental Research and Public Health, 6, 2822–2832. doi:10.3390/ijerph6112822.
  • Bobes, J., González, M. P., Saiz, P. A. y Bousoño, M. (1996). Índice Europeo de Severidad de la Adicción: EuropASI. Versión española. Actas de la IV Reunión Interregional de Psiquiatría, 201-218.
  • Daigre, C., Comín, M., Rodríguez-Cintas, L., Voltes, N., Alvarez, A., Roncero, C., … Casas, M. (2010). Users’ perception of a harm reduction program in an outpatient drug dependency treatment center. Gaceta Sanitaria / S.E.S.P.A.S, 24, 446–452. doi:10.1016/j.gaceta.2010.09.007.
  • Faggiano, F., Vigna-Taglianti, F., Versino, E., y Lemma, P. (2003). Methadone maintenance at different dosages for opioid dependence. The Cochrane Database of Systematic Reviews, (3). doi:10.1002/14651858.CD002208.
  • Fernández Miranda, J., González García-Portilla, M., Sáiz Martínez, P., Gutiérrez Cienfuegos, E. y Bobes García, J. (2001). Influence of psychiatric disorders in the effectiveness of a long-term methadone maintenance treatment. Actas Españolas de Psiquiatría, 29, 228–232.
  • First, M.B., Spitzer, R.L., Gibbon, M. y Williams, J.B.W. (1999). Entrevista clínica estructurada para los trastornos del eje I del DSM-IV. Barcelona: Masson.
  • First, M.B., Gibbon, M., Spitzer, R.L., Williams, J.B.W. y Smith, B. (1999). Entrevista Clínica Estructurada para los Trastornos de la Personalidad del Eje II del DSMIV. Barcelona: Masson.
  • Grau-López, L., Roncero, C., Daigre, C., Gonzalvo, B., Bachiller, D., Rodriguez-Cintas, L. … Casas, M. (2012). Risk factors of relapse in drug dependent patients after hospital detoxification. Adicciones, 24, 115-122. 
  • Havinga, P., van der Velden, C., de Gee, A. y van der Poel, A. (2014). Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the Netherlands. Harm Reduction Journal, 11, 6. doi:10.1186/14777517-11-6.
  • Herrero, M. J., Domingo-Salvany, A., Brugal, M. T., Torrens, M. y Itinere Investigators. (2011). Incidence of psychopathology in a cohort of young heroin and/or cocaine users. Journal of Substance Abuse Treatment, 41, 55–63. doi:10.1016/j.jsat.2011.01.013.
  • Hopfer, C.J., Khuri, E., Crowley, T.J. y Hooks, S. (2002). Adolescent heroin use: a review of the descriptive and treatment literature. Journal of Substance Abuse Treatment, 23, 231-237.
  • International Harm Reduction Association (2009). Global Overview: Drugs, HIV and Hepatitis C, 2009. Recuperado de http://www.ihra.net/global-overview.
  • International Harm Reduction Association (2010). What is Harm Reduction: A position statement from the International Harm Reduction Association. IHRA Briefing, London United Kingdom, April 2010. Recuperado de http://www.ihra.net.
  • Jhanjee, S., Lal, T., Mondal, A. y Jain, K. (2011). Heroin-dependent family: a biopsychosocial context. Substance Abuse, 32, 157–158. doi:10.1080/08897077.2011.558450.http://doi.org/10.1002/14651858.CD002208 http://www.ihra.net/global-overview http://www.ihra.net
  • Kokkevi, A. y Hartgers, C. (1995). EuropASI: European Adaptation of a Multidimensional Assessment Instrument for Drug and Alcohol Dependence. European Addiction Research, 1, 208-210.
  • Krug, A., Hildebrand, M. y Sun, N. (2015). “We don’t need services. We have no problems”: exploring the experiences of young people who inject drugs in accessing harm reduction services. Journal of the International AIDS Society, 18, S19442. doi:10.7448/IAS.18.2.19442.
  • Kwan, T. H., Wong, N. S. y Lee, S. S. (2015). Participation dynamics of a cohort of drug users in a low-threshold methadone treatment programme. Harm Reduction Journal, 12, 30. doi:10.1186/s12954-015-0072-z.
  • MacArthur, G. J., van Velzen, E., Palmateer, N., Kimber, J., Pharris, A., Hope, V., … Hutchinson, S. J. (2014). Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. The International Journal on Drug Policy, 25, 34–52. doi:10.1016/j.drugpo.2013.07.001.
  • Marie-Claire, C., Crettol, S., Cagnard, N., Bloch, V., Mouly, S., Laplanche, J. L. … Vorspan, F. (2016). Variability of response to methadone: genome-wide DNA methylation analysis in two independent cohorts. Epigenomics, 8,181-195. doi:10.2217/epi.15.110.
  • Martínez-Luna, N., Palma-Álvarez, R. F. y Roncero, C. (2016). Reducción de Daños. E: C. Roncero y M. Casas, ed., Patología Dual, Fundamentos Clínicos y Terapéuticos, 1st ed. Barcelona: Marge Medica Books, pp.253-266.
  • McNeil, R., Kerr, T., Pauly, B., Wood, E. y Small, W. (2016). Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals. Addiction, 111, 685–694. doi: 10.1111/ add.13214.
  • Miguel-Arias, D., Pereiro Gómez, C., Bermejo Barrera, A.M., López de Abajo Rodríguez, B. Y Sobrino Prieto, M. (2016). Mortality due to acute adverse drug reactions in Galicia: 1997-2011. Adicciones, 28, 80-89. doi:10.20882/ adicciones.780.
  • Observatorio Español de la Droga y las Toxicomanías. (2015). Informe 2015. Recuperado de http://www. pnsd.msssi.gob.es/profesionales/sistemasInformacion/ informesEstadisticas/pdf/INFORME_2015.pd.
  • Palmateer N., Kimber, J. Hickman, M., Hutchinson, S., Rhodes, T. y Goldberg, D. (2010). Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews. Addiction, 105, 844–859. doi:10.1111/j.13600443.2009.02888.x.
  • Parvaresen, N., Masoudi, A., Majidi-Tabrizi, S. y Mazhari, S. (2012). The Correlation between Methadone Dosage and Comorbid Psychiatric Disorders in Patients on Methadone Maintenance Treatment. Addiction and Health, 4, 1-8.
  • Peles E., Schreiber, S., Domany, Y. y Adelson, M. (2014). Impact of lifetime psychiatric diagnosis on long-term retention and survival of former opiate addicts in methadone maintenance treatment. The World Journal of Biological Psychiatry, 15, 629-635. doi:10.3109/15622975.2014.942359.
  • Pereiro, C., Pino, C., Flórez, G., Arrojo, M., Becoña, E. y COPSIAD Group. (2013). Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study. PloS One, 8, e66451. doi:10.1371/journal.pone.0066451.
  • Rhodes, T. y Hedrich, D. (2010). Harm Reduction: Evidence, Impact and Challenges. EMCDDA. Recuperado de http://www.emcdda.europa.eu/publications/monographs/harm-reduction.
  • Roncero, C., Barral, C., Rodríguez-Cintas, L., Pérez-Pazos, J., Martinez-Luna, N., Casas, M., … Grau-López, L. (2016). Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study. Psychiatry Research, 243, 174–181. doi:10.1016/j.psychres.2016.06.024.
  • Roncero, C., Daigre, C., Grau-López, L., Rodríguez-Cintas, L., Barral, C., Pérez-Pazos, J., … Casas, M. (2013a). Cocaine-induced psychosis and impulsivity in cocaine-dependent patients. Journal of Addictive Diseases, 32, 263273. doi:10.1080/10550887.2013.824330.
  • Roncero, C., Fuste, G., Barral, C., Rodríguez-Cintas, L. Martínez-Luna, N. Eiroa-Orosa, F.J… Casas, M. on behalf of the PROTEUS study investigators. (2011). Therapeutic management and comorbidities in opiate-dependent patients undergoing a replacement therapy programme in Spain: the PROTEUS study. Heroin Addiction and Related Clinical Problems, 13, 5-16.
  • Roncero, C., Grau-López, L., Palma-Álvarez, R. F., Rodriguez-Cintas, L., Ros-Cucurull, E., Esojo, E. y Daigre, C. (2017). Higher severity of cocaine addiction is associated with tactile and somatic hallucination. European Psychiatry, 42, 63-69. doi:10.1016/j.eurpsy.2016.11.006.
  • Roncero, C., Martínez-Luna, N., Daigre, C., Grau-López, L., Gonzalvo, B., Pérez-Pazos, J. y Casas, M. (2013b). Psychotic symptoms of cocaine self-injectors in a harm reduction program. Substance Abuse, 34, 118-121. doi:10. 1080/08897077.2012.691446.
  • Salamina, G., Diecidue, R., Vigna-Taglianti, F., Jarre, P., Schifano, P., Bargagli, A. M., … VEdeTTE Study Group. (2010). Effectiveness of therapies for heroin addiction in retaining patients in treatment: results from the VEdeTTE study. Substance Use & Misuse, 45, 2076–2092. doi:10.3109/10826081003791932.
  • San, L., Arranz, B., Arrojo, M., Becoña, E., Bernardo, M., Caballero, L., … Zorrilla, I. (2016). Clinical guideline for the treatment of dual pathology in the adult population. Adicciones, 28, 3-5. doi:10.20882/adicciones.784.
  • Seal, K. H., Kral, A. H., Gee, L., Moore, L. D., Bluthenthal, R. N., Lorvick, J. y Edlin, B. R. (2001). Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998-1999. American Journal of Public Health, 91, 18421846.
  • Teoh Bing Fei, J., Yee, A. y Habil, M. H. (2016). Psychiatric comorbidity among patients on methadone maintenance therapy and its influence on quality of life. American Journal of Addiction, 25, 49-55. doi:10.1111/ ajad.12317.
  • Torrens, M., Fonseca, F., Castillo, C. y Domingo-Salvany, A. (2013). Methadone maintenance treatment in Spain: the success of a harm reduction approach. Bulletin of the World Health Organization, 91, 136–141. doi:10.2471/ BLT.12.111054.
  • Wang, X., Zhang, T. y Ho, W. Z. (2011). Opioids and HIV/ HCV infection. Journal of Neuroimmune Pharmacology: The Official Journal of the Society on NeuroImmune Pharmacology, 6, 477–489. doi:10.1007/s11481-011-9296-1.
Fuente de los datos: Dialnet