Faculty of Medicine

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    Frequency of cannabis and amphetamine use past month in patients on opioid maintenance treatment with buprenorphine
    (2024-10-23)
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    Bekarovski, Niko
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    Background Maintenance treatment for opioid use disorder, either with methadone or buprenorphine-based medications, improves retention in the treatment and reduces abuse of illicit opioids. We aimed to examine the cannabis and amphetamine use before and while the treatment with buprenorphine, as well as the correlation of this findings with the demographic characteristics and duration of opioid use disorder. Methods This analytical cross-sectional study was implemented at the Skopje University Clinic for Toxicology. Participants diagnosed with opioid use disorder receiving pharmacological treatment buprenorphine, were asked to self-report the past month cannabis and amphetamine use. Specially for this study designed questionnaire adapted to the “treatment demand indicator” was used to collect the data. Results Тotal of 112 participants (88.39% male and 11.61% female) were enrolled. Before the buprenorphine treatment, cannabis use was permanent in 60 (53.57%), and periodic or not used in 52 (46.43%) participants, and amphetamine use was permanent in 40 (35.71%), and periodic or not used in 72 (64.29%) participants. After the buprenorphine treatment cannabis was not used or used occasionally by 71 (63.39%) of the participants, ones per week or less was used by 14 (12.50%), 2-6 days per week was used by 9 (8.04%), daily used by 6 (5.36%) and unknown by 12 (10.71%) participants, with not significant association with the gender (p=0.732). negative not significant correlation with the age (R=-0.011; p=0.951) and positive not significant correlation with the duration of opioid dependence (R=0.032; p=0.733). Amphetamine after the buprenorphine treatment was not used or used occasionally by 103 (91.96%) participants, used ones per week or less by 6 (5.36%) and 2-6 days per week by 3 (2.68%) participants with significant association of male gender with no use (p=0.009), negative not significant correlation with the age (R=-0.073; p=0.445) and positive not significant correlation with the duration of opioid dependence (R=0.027; p=0.774). Conclusions Before starting treatment of opioid use disorder with buprenorphine, more than half of the patients had a permanent use of cannabis, while more than a third use amphetamines. After initiation of buprenorphine treatment, although some of the patients occasionally use cannabis and amphetamines, the permanent use of these psychoactive substances is reduced.
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    CANNABIS AND AMPHETAMINE USE IN PATIENTS ON BUPRENORPHINE MAINTENANCE TREATMENT
    (2023-05)
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    Niko Bekarovski
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    Andon Chibishev
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    Polydrug abuse is a known problem among patients on opioid maintenance treatment. Objective is to assess the profile of patients on buprenorphine substitution treatment who use cannabis, amphetamine or cannabis and amphetamine in parallel. This study was conducted in 2021 year at University Clinic for toxicology, Skopje and has a prospective cohort design that included 112 patients with opioid use disorder on buprenorphine maintenance treatment. The data were collected according to a previously designed self-administered questionnaire adapted according to the “treatment demand indicator”. The following variables were analyzed: gender, age, duration of opioid use disorder, route of administration, duration of buprenorphine treatment, buprenorphine dose, cannabis and amphetamine use. The majority of patients were male (88.4%). The mean age of patients was 38.7±4.3 years. The average duration of opioid use disorder was 16.8±6.8 years; the duration of buprenorphine treatment was 6.3±3.3 years; buprenorphine dose was 12.5±4.9mg. Parallel use of buprenorphine with cannabis was declared in 43.7% of the patients and they were significantly younger compared to others (p=0.014). A combination of buprenorphine with amphetamine was used in 14.3% with significantly younger ages compared to others (p=0.003). Buprenorphine with both cannabis and amphetamine was practiced in 15.2% of the patients. No significant correlation was found between other variables of the studied group and the parallel use of cannabis and amphetamine. Almost half of the patients on buprenorphine substitution treatment reported parallel use of cannabis. The patients who declared parallel use of cannabis and amphetamines were of younger age compared to others.
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    Physical birth outcomes in neonates prenatally exposed to buprenorphine – our first experiences
    (2019-09-17)
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    Introduction/Objective Buprenorphine appears generally similar to, and in some cases superior to, methadone in terms of maternal, fetal, and neonatal outcomes. The objective of the study was to assess some physical birth outcomes in neonates prenatally exposed to buprenorphine. Methods During a seven-year period, nine patients have been treated with buprenorphine during their pregnancy. All women underwent interview, clinical investigations, biochemical analysis, toxicological screening, viral markers for hepatitis B, C, HIV, with regular check-ups by an obstetrician and a psychiatrist. Newborn outcomes included: birth weight in grams, birth length in centimeters, physical anomalies, head/chest circumference in centimeters, Apgar score at 1 minute / 5 minutes, gestational age (weeks), newborn length of hospital stay in days, breast-feeding, the newborn’s need for pharmacologic treat￾ment after delivery. Results The mean birth weight was 2,991.11 ± 37 g; birth length was 49.44 ± 2.29 cm; head circumference was 33.11 ± 0.78 cm; chest circumference was 32.33 ± 1 cm; first minute Apgar score was 8.22, fifth minute 9.22; age at delivery was 38.77 ± 1.09 weeks; hospitalization after delivery 4.44 ± 1.13 days. None of the newborns had physical anomalies. Six of the newborns were breastfed. Conclusion Buprenorphine is a safe and important part of a complete comprehensive treatment approach in pregnant women with opioid use disorder. Buprenorphine treatment of maternal opioid use disorder indicated a low risk of preterm birth, normal birth weight and length, head and chest circumference, Apgar score, short hospitalization after delivery.