Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

Rachel Lamont; Tea Rosic; Nitika Sanger; Zainab Samaan

doi:10.1093/schizbullopen/sgaa007

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

Schizophr Bull Open. 2020 Jan;1(1):sgaa007. doi: 10.1093/schizbullopen/sgaa007. Epub 2020 Mar 2.

Authors

Rachel Lamont¹, Tea Rosic^{1

2}, Nitika Sanger³, Zainab Samaan^{1

2}

Affiliations

¹ Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
³ Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada.

Abstract

Background and objectives: Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD).

Methods: Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis.

Results: Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024).

Discussion and conclusions: This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.

Keywords: medication-assisted treatment; methadone; opioid addiction; psychiatric comorbidity; psychotic disorder; schizophrenia.

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