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Heroin Addiction and Related Clinical Problems: 2024, 26, 18

The severity of Heroin Use Disorder in patients at treatment entry and their therapeutic response to Opioid Agonist Treatment

Filippo Della Rocca, Francesco Lamanna, Lucia Massa, Giulia De Luca, Mario Miccoli, Icro Maremmani, and Angelo G. I. Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2024-18

Summary: Introduction. To date, neither biological correlates nor standardised clinical parameters exist to set up a Heroin Use Disorder (HUD) patient-tailored treatment and monitor outcomes during Opioid Agonist Treatment (OAT). Methods. In the present study - on a sample of HUD outpatients - we explored treatment responses during OAT. We considered two subgroups of patients, moderately ill (MI-GR) and severely ill (SI-GR), according to the severity of heroin addiction history. Treatment response indices were based on patient-reported data on demographic characteristics, psychopathological symptoms (assessed with the SCL-90), stress sensitivity (H/PTSD-S), subjective well-being (D-SWS) and behavioural covariates of craving for heroin (CRAV-Hero), alcohol (ACS), cocaine (CPSI) and cannabis (MCQ12). Results. Compared to MI-GR, SI-GR patients tended to be unemployed and to show a lower response to OAT in most psychopathological symptoms, stress sensitivity and subjective well-being rates. In contrast, SI-GR subjects showed a better response than MI-GR subjects on behavioural covariates of heroin craving, particularly on time-related behavioural items. In terms of correlations, the length of current treatment was negatively correlated with the overall severity of illness at treatment entry, severity of behavioural covariates of heroin craving and severity of stress sensitivity. Methadone and buprenorphine dosages showed negative correlations only with the time of treatment retention and overall severity of craving for cannabis, respectively. Conclusions. Information from patients’ specific psychopathology, behavioural covariates of craving, stress sensitivity and subjective wellness of individuals can provide new clinical information for monitoring patients undergoing OAT. They could be the key to better tailoring diagnostic and therapeutic interventions, finally paving the way from harm reduction to patient-tailored therapy in OAT.

Keywords: Standardised clinical parameters; patient-tailored treatment; monitoring outcomes during OAT; assessing heroin use disorder