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  • Publication
    Factors associated with discontinuation of methadone maintenance therapy (MMT) among persons who also use alcohol in Vancouver, Canada
    Background We sought to examine the factors associated with discontinuation of MMT among persons on methadone who use alcohol. Methods We evaluated the impact of drug-related and other factors on discontinuation of MMT among persons enrolled in MMT and who reported any use of alcohol versus those who were enrolled in two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Extended Cox models with time-dependent variables identified factors independently associated with time to first MMT discontinuation. Results Between December 2005 and 2015, 823 individuals on MMT who also reported using alcohol at least once were included in these analyses. During the study period, 391 (47.5%) discontinued methadone. Daily heroin injection (Adjusted Hazard Ratio [AHR] = 2.67, 95% Confidence Interval [CI]: 2.10–3.40) and homelessness (AHR = 1.42, 95% CI: 1.10–1.83) were positively associated with MMT discontinuation, whereas receiving other concurrent addiction treatment in addition to MMT (AHR = 0.07, 95% CI: 0.05–0.08), as well as >60 mg methadone dose (AHR = 0.48, 95% CI: 0.39–0.60), Hepatitis C virus seropositivity (AHR = 0.65, 95% CI: 0.47–0.90), and HIV seropositivity (AHR = 0.72, 95% CI: 0.57–0.91) were negatively associated with MMT discontinuation. Any/heavy alcohol use was not independently associated with MMT discontinuation. Conclusions This study reinforces the known risks of continued heroin injection and homelessness for MMT discontinuation among individuals who also consume alcohol and highlights the protective effect of both MMT dose and receipt of concurrent addiction treatment.
      282Scopus© Citations 10
  • Publication
    Prevalence of Heavy Alcohol Use Among People Receiving Methadone Following Change to Methadose
    (Taylor & Francis, 2017-06) ; ; ;
    BACKGROUND: A recent switch in methadone formulation from methadone (1 mg/mL) to Methadose (10 mg/mL) in British Columbia (BC), Canada, was associated with increased reports of opioid withdrawal and increases in illicit opioid use. Impacts on other forms of drug use have not been assessed. Since alcohol use is common among people receiving Medication-Assisted Treatment (MAT), we assessed if switch was associated with increased prevalence of heavy alcohol use. METHODS: Drawing on data from two open prospective cohort studies of people who inject drugs in Vancouver, BC, generalized estimating equations (GEE) model examined relationship between methadone formulation change and heavy alcohol use, defined by National Institute for Alcohol Abuse and Alcoholism (NIAAA). A sub-analysis examined relationship with heavier drinking defined as at least eight drinks per day on average in last six months. RESULTS: Between June 2013 and May 2015, a total of 787 participants on methadone were eligible for the present analysis, of which 123 (15.6%) reported heavy drinking at least once in last six months. In an unadjusted GEE model, Methadose use was not significantly associated with an increased likelihood of heavy drinking [Odds Ratio (OR) = 1.03; 95% Confidence interval (CI) = 0.87-1.21]. Methadose use was not significantly associated with an increased likelihood of drinking at least eight drinks daily on average (OR = 1.09, 95% CI = 0.72-1.65). CONCLUSIONS: Despite reported changes in opioid use patterns coinciding with the change, there appeared to be no effect of the methadone formulation change on heavy drinking in this setting.
      333Scopus© Citations 3