Co-occurring opioid use disorder and serious mental illness: A selective literature review

Impact of Co-Occurring Psychiatric Comorbidities and Substance Use Disorders on Outcomes in Adolescents and Young Adults with Opioid Use Disorder: A Retrospective Cohort Study

Background/Objectives: Adolescents and young adults (AYAs) with opioid use disorder (OUD) frequently have co-occurring psychiatric conditions and substance use disorders (SUDs). This study evaluated the association of psychiatric comorbidities and other SUDs with treatment retention and urine drug test (UDT) results in AYAs with OUD. Methods: This retrospective cohort study included AYAs enrolled in the Substance Use Treatment and Recovery clinic from 2009 to 2022. Participants were categorized into four groups: no comorbidities, only mental health disorders, only other SUDs, and both disorders. Treatment outcomes included retention time and UDT results for medication for OUD (MOUD) and illicit substances, including tetrahydrocannabinol (THC). Kruskal-Wallis tests were used to evaluate differences across groups, and regression models identified variables associated with outcomes. Statistical significance was set at p < 0.05. Results: Among 157 patients, the median retention time was 300 days. Depression (p = 0.04), post-traumatic stress disorder (p = 0.002), and alcohol use disorder (p = 0.04) were associated with prolonged retention, whereas cannabis use disorder predicted shorter retention (p = 0.02). The median proportion of positive UDTs was 0.9 for MOUD, 0.1 for illicit substances, and 0.0 for THC. Older age (p = 0.02) and the use of antidepressants and anxiolytics were associated with greater adherence to MOUD. Cannabis use disorder (p = 0.02) and male sex (p = 0.04) predicted positive UDTs for THC, while MOUD use was linked to lower THC positivity (p = 0.02). The main limitations of this study were related to its retrospective study design and single-center setting. Conclusions: Psychiatric and substance use comorbidities significantly influence retention and treatment adherence in AYAs with OUD. Integrated treatment may improve engagement and outcomes. Further research is needed to tailor interventions for AYAs with co-occurring disorders.

Risk Factors for Infective Endocarditis and Serious Injection Related Infections Among People Who Inject Drugs in Los Angeles, CA and Denver, CO

BACKGROUND

Injection drug use-related infective endocarditis (IDU-IE) and bacterial infections have grown in the United States, but little is known about risk factors for these infections in community samples of people who inject drugs (PWID).

METHODS

During 2021-22, PWID were recruited from community settings and surveyed for history of IDU-IE, serious injection related symptoms (SIRI) and untreated infection symptoms in the last 3 months. We used bivariate analysis and multiple logistic regression to examine factors associated with these outcomes.

RESULTS

Among participants (n = 472), 7 % reported ever having IDU-IE, 14 % reported having SIRI symptoms and 20 % reported untreated infection symptoms in the last 3 months. Ever having IDU-IE was associated with HCV (adjusted odds ratio [AOR]=8.37; 95 % confidence interval [CI]=2.46, 28.49), prior MRSA infection (AOR=5.37; 95 % CI=2.44, 11.80), identifying as female and/or gender minority person (AOR=3.14; 95 % CI=1.42, 6.95). SIRI symptoms were associated with greater material hardship (compared to low; AOR=2.47; 95 % CI=1.17, 5.22), fentanyl use (AOR=2.15; 95 % CI=1.01, 4.61), sharing filter/cotton (AOR=1.93; 95 % CI=1.10, 3.39), and licking needle prior to injection (AOR=1.85; 95 % CI=1.02, 3.36). Untreated infection symptoms were associated with poor quality sleep (AOR=2.04; 95 % CI=1.21, 3.43), any mental health diagnoses (AOR=2.01; 95 % CI=3.56), any chronic pain (AOR=1.89; 95 % CI=1.14, 3.11), sharing filters (AOR=1.81; 95 % CI=1.10, 2.98), and prior MRSA infection (AOR=1.75; 95 % CI=1.04, 2.97).

CONCLUSION

Risk factors identified include treatable co-morbidities (i.e., HCV & MRSA history, mental health, pain, opioid use), modifiable health behaviors (i.e., equipment sharing, needle-licking), and addressable structural conditions (material hardship, housing).

Exploring mental health comorbidities and opioid agonist treatment coverage among people in prison: A national cohort study 2010-2019

INTRODUCTION

Despite a high prevalence of opioid use disorder (OUD) among people in prison, there is little knowledge of how many receive the recommended opioid agonist treatment (OAT) and what characterizes those who receive OAT and those who do not when it comes to mental health comorbidities. We aimed to describe people with OUD in Norwegian prisons over a ten-year period and their OAT status, and to investigate comorbidity of mental health disorders stratified by gender.

METHODS

Data from the PriSUD study, including all people (≥19 years old) imprisoned in Norway between 2010 and 2019, linked to national patient registry data, including ICD-10 codes. We calculated the prevalence (1-year and 10-year) of OUD and OAT, and mental health comorbidity stratified on OAT-status and gender.

RESULTS

Among the cohort (n=51,148), 7 282 (14.2%) were diagnosed with OUD during the period of observation. Of those, 4 689 (64.4%) received OAT. People with OUD had high levels of comorbidity, including other drug use disorders (92.4% OAT, 90.3% non-OAT), alcohol use disorder (32.1% OAT, 44.4% non-OAT) and any other mental health disorders (61.6% OAT, 68.2% non-OAT). The proportion receiving OAT among people with OUD increased markedly during the ten years of observation; from 35.7% in 2010-70.9% in 2019.

CONCLUSION

People with OUD, both receiving OAT and not, had substantially more mental health comorbidities than the non-OUD population. Understanding how the prison population changes over time especially in terms of mental health needs related to OUD, is important for correctional health service planning.