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Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: To analyse predictors of heroin abstinence in opiate substitution therapy (OST) based on frequency of crack use and its interactions with other predictors.

Methods:

Design: Retrospective study.

Setting: A community drug service in London, UK.

Participants: Clinical records of 325 clients starting OST between 2010 and 2014 (197 methadone and 128 buprenorphine).

Measurements: Logistic regression models (a general model and separate models for methadone and buprenorphine) assessed demographic and clinical data as predictors of heroin abstinence at one year after treatment start.

Results: For the general model participants choosing methadone were more likely to use heroin at follow up (OR=2.36, 95% CI: 1.40 – 3.17) as were daily crack users on methadone (OR=2.62, 95% CI: 0.96  –  7.16). For the methadone model, only daily crack use predicted heroin use at follow up (OR = 2.62, 95% CI: 0.96  –  7.16). For buprenorphine, higher amounts of baseline heroin use, lower buprenorphine dose and daily drinking predicted heroin use at follow up (OR=0.85, 95% CI: 0.75 – 0.95; OR=1.31, 95% CI: 1.06 – 1.60 and OR=6.04, 95% CI: 1.26 – 28.92). Both the use of cannabis and depression increased likelihood of heroin abstinence for clients not using crack compared to occasional (OR=6.68, 95% CI: 0.37 – 119.59; OR=106.31, 95% CI: 3.41 – 3313.30) and daily (OR=57.49 (95% CI: 2.37 – 1396.46; OR=170.99 (95% CI: 4.61 – 6339.47) users.

Conclusions: Most of the predictors in the general model were found significant only in the buprenorphine but not in the methadone model, suggesting that a general model has little predictive value. For methadone, daily crack use predicted heroin use, and for buprenorphine, no crack use predicted heroin abstinence only when depression or cannabis use was present. Further research is needed to assess effective treatment approaches for the growing population of dual users.

Co-Authors

Mary Bell MacLeod, Camden and Islington NHS Foundation Trust, London, UK Lynne Dawkins, London South Bank University, London, UK

Conflicts of interest:

No conflicts of interest

Report Author

Dr Felicia Heidebrecht

SUbstance Misuse Practitioner/Researcher


Felicia has completed her PhD in biology in Germany and has worked for over 10 years in biological and preclinical research. After developing an interest in psychoactive drugs she completed her MSc in psychology, and worked for three years in community drug and alcohol services as substance misuse practitioner and researcher. She decided to focus on the dual use of heroin and crack after witnessing the difficulties dual users encounter in achieving heroin abstinence.

Currently she works within the Research and Development Department of the Barnet, Enfield and Haringey Mental Health NHS Trust, but continues her research on heroin and crack use on an honorary contract as visiting researcher with the London South Bank University. Her future aspirations are to conduct biopsychological research in mental health and substance misuse.

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