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Heroin Addiction and Related Clinical Problems: 2015, 17, 1 (pages: 33 - 42)

Prescription opioids (substitution medications and pain medications) in patients looking for Opioid Agonist Treatment in Northern and Southern Italy, using a 18-month survey methodology

Maremmani I., Guareschi M., Deruvo G., Somaini L., Maremmani A.G.I., Green J., McBride K., and Dart R.C.

Summary: Background: In many countries, the broad availability of prescription pain medications (PPMs) and prescription substitution medications (PSMs), coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in the non-medical use of prescription opioids (POs), and corresponding increases in treatment admissions for problems related to opioid misuse. This Italian study has aimed to assess the prevalence of the primary substance of abuse, the differences between heroin use and the use of POs in the previous month and the prevalence of combined use (heroin, PSMs and PPMs), while stressing the geographical differences between Northern and Southern Italy. Methods: This has been a cross-sectional, observational study. The data were collected prospectively, over an 18-month period in 2012 e 2013. The Survey Questionnaire on Opioids was administered during an 18-month survey to all patients entering Opioid Agonist Treatment (OAT) in two National Health Drug Addiction Units – the first in Northern and the second in Southern Italy. Results: 317 subjects requested OAT at Drug Addiction Units in the cities of Cossato and Bitonto, in Southern and in Northern Italy, respectively. Heroin was named most frequently as the primary substance of abuse, followed by PSMs (buprenorphine and methadone). Heroin was the substance most used in the previous 30 days, followed by PSMs. About half of the patients were only using heroin, approximately a quarter PSMs only, 15% heroin and PSMs together, and 10% PPMs only. Northern Italian patients were characterized by the combined use of heroin and PSMs (OR=0.025), but also by using PPMs – in order of importance, codeine (OR=0.008), oxycodone (OR=0.011), and tramadol (OR=0.013) – as their primary substance of abuse. Conclusions: In Italy, in patients requesting OAT, the most frequent primary substance of abuse and the most frequently used substance in the previous 30 days is still heroin. As in many other countries, however, the use of POs is increasing, especially if we consider the combined use of heroin and PSMs. In Italy, the dreaded transition from PPMs to heroin still seems almost non-existent, and is just beginning to appear, but only in Northern Italy.