Cognition and Opioid Substitution Therapy Adherence in Patients with Opioid Dependence VC01-VC05
Dr. Shabina A Sheth,
Ameen-E-Shariat Street, Opposite Sarvodaya Society, Pologround, Sabarkantha, Himatnagar-383001, Gujarat, India.
Introduction: Opioid Substitution Therapy (OST) is an effective long term treatment option for opioid dependence as well as Human Immunodeficiency Virus (HIV) prevention and intervention for opioid dependent Intravenous Drug User (IDUs). Department of Psychiatry is running DOST centre for opioid dependent patients for last four years. The dropout rates are also high.
Aim: To assess the cognition, medical complications, social, financial impact of opioid addiction and to study correlation of cognition with OST adherence in patients with opioid dependence.
Materials and Methods: The cross-sectional study was conducted in the DOST Centre, OPD-13, New Civil Hospital, Surat, Gujarat, India, in August 2015. All 22 patients taking OST as a part of DOTS in DOST centre (name of the OST centre) were enrolled in this study. After giving ‘Participant Information Sheet’ informed valid consent were taken from all participants. Semistructured questionnaire which investigated qualitative and quantitative information about opioid and other substance use with related complications, scales Addenbrooke’s Cognitive Examination-III (ACE-III) Hindi and Mini Mental State Examination (MMSE) for cognitive assessment were used and analysed.
Results: Out of 22 patients coming to DOST centre for OST 22.72%, 31.81% and 45.45% patients were Irregular (IR), Regular (R), Very Regular (VR) respectively (as per, criteria given by NACP-IV). Mean MMSE score in IR, R and VR patients were 21.8, 23.29, 22.8 respectively and ACE-III score in IR, R and VR patients are 63.2, 79.57, and 67.9 respectively. Patients who were non adherent and irregular had statistically significant lower ACE-III score (p=0.032). Cognition (ACE-III) and adherence showed a statistically significant linear positive relationship (p<0.001) with moderate strength on Pearson’s correlation test.
Conclusion: As there is no significant result outcome regarding comparison of adherence with other variables like education, marital status, socioeconomic status, social support, it can be concluded that the only robust factor which affects OST adherence is cognitive decline of the patient which is responsible for no behavioural changes, harmful use, relapse and not maintaining abstinence in opioid dependent patients.