Change in alcohol and other drug use during five years of continuous opioid substitution treatment

Brian Eastwood*, John Strang, John Marsden

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: English national prospective, observational cohort study of patients continuously enrolled for five years in opioid substitution treatment (OST) with oral methadone and sublingual buprenorphine. This is a secondary outcome analysis of change in use of alcohol and other drug use (AOD) following identification of heroin use trajectories during OST. Methods: All adults admitted to community OST in 2008/09 and enrolled to 2013/14 (n = 7717). Data from 11 sequential, six-monthly clinical reviews were used to identify heroin and AOD use trajectories by multi-level Latent Class Growth Analysis. OST outcome in the sixth and seventh year was ‘successful completion and no re-presentation’ (SCNR) to structured treatment and was assessed using multi-level logistic regression. Results: With ‘rapid decreasing’ heroin use trajectory as referent, ‘continued high-level’ heroin use predicted ‘continued high-level’ crack cocaine use (relative risk ratio [RRR] 58.7; 95% confidence interval [CI] 34.2–100.5),‘continued high-level’ alcohol use (RRR 1.2; 95% CI 1.0–1.5), ‘increasing’ unspecified drug use (RRR 1.7; 95% CI 1.4–2.1) and less ‘high and increasing’ cannabis use (RRR 0.5; 95% CI 0.4–0.6). ‘Increasing’ crack use was negatively associated with SCNR outcome for the ‘decreasing then increasing’ and ‘gradual decreasing’ heroin use groups (adjusted odds ratio [AOR] 0.5; 95% CI 0.3–0.9 and AOR 0.2; 95% CI 0.1–0.7, respectively). Conclusions: Continued high-level heroin use non-response during long-term OST is associated with high-level crack cocaine and alcohol use, increasing unspecified drug use, but less high and increasing cannabis use. Increasing use of crack cocaine is negatively associated with the likelihood that long-term OST is completed successfully.

Original languageEnglish
Pages (from-to)438-446
Number of pages9
JournalDrug and Alcohol Dependence
Publication statusPublished - 1 Jan 2019

Bibliographical note

Funding Information:
J.M. declares investigator-led, educational grant funding from Indivior (administered by Action-on-Addiction) for a study of personalised psychosocial intervention for non-response to opioid agonist treatment (ARC Trial), and support from NIHR (HTA) for a trial of extended-release naltrexone. He acknowledges part-time employment as Senior Academic Advisor for the Alcohol, Drugs and Tobacco Division, Health Improvement, Public Health England and consultancy with the US National Institute on Drug Abuse, Centre for Clinical Trials Network. In the past 3 years, he received honoraria from Merck Serono (2015; clinical oncology training); Martindale (2017; expert meeting on OUD); and Indivior (via PCM Scientific) as co-chair (2015, 2016) and chair (2017) for the conference on Improving Outcomes in Treatment of Opioid Dependence.

Funding Information:
J.S. a researcher and clinician who has worked with a range of types of treatment and rehabilitation service-providers. J.S. is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. He has also worked with a range of governmental and non-governmental organisations, and with pharmaceutical companies to seek to identify new or improved treatments from whom he and his employer (King’s College London) have received honoraria, travel costs and/or consultancy payments. This includes work with, during past 3 years, Martindale, Reckitt-Benckiser/Indivior, MundiPharma, Braeburn/MedPace and trial medication supply from iGen. His employer (King’s College London) has registered intellectual property on a novel buccal naloxone formulation and he has also been named in a patent registration by a Pharma company as inventor of a concentrated nasal naloxone spray. For a fuller account, see JS’s web-page at .

Funding Information:
Resource costs for the study were supported by the Alcohol, Drugs, Tobacco and Justice Division, Health Improvement Directorate, Public Health England. The contents of this article do not necessarily reflect the views or stated position of PHE.

Publisher Copyright:
© 2018


  • Alcohol
  • Cannabis
  • Cocaine
  • Long-term
  • Opioid substitution treatment
  • Trajectory


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