Short CommunicationGender-related psychopathology in opioid use disorder: Results from a representative sample of Italian addiction services
Introduction
Opioid use disorder (OUD) is a chronic, severe disease characterized by significant relapse rates, increased incidence of mortality and disability, as well as multiple medical and psychiatric comorbidities. Opioid substitution treatment (OST), often combined with psychosocial interventions, is considered to be the first-line treatment in chronic OUD management (Olsen & Sharfstein, 2014). Among the 700,000 estimated OUD individuals attending opioid-assisted maintenance programs in EU, methadone is the most extensively prescribed opioid agonist medication, with over 480,000 (69%) OUD subjects having received methadone in 2013, followed by a 28% treated with buprenorphine (Mounteney et al., 2016). Other compounds, including levo-acethylmethadol, codeine, and slow-release morphine are less common treatment strategies (EMCDDA, 2015, Nielsen et al., 2016).
Although maintenance treatments have been widely shown to be effective in OUD, high inter-individual response variability has been observed among patient receiving OST (Li, Kantelip, Gerritsen-van Schieveen, & Davani, 2008). Different therapeutic needs, as well as distinct clinical features, have been hypothesized to account for this variance.
Several gender differences about risk factors, disease severity, pattern of substance consumption and related behaviors have been observed in OUD, with women usually reporting multiple medical comorbidities, higher craving levels and severe socio-relational impairment (Back et al., 2011). Moreover, OUD women are more likely to present a co-occurrent mental disorder, as well as higher rates of psychopathology (Fareed et al., 2013, Grella et al., 2009). In particular, psychopathological symptoms, along with full-blown psychiatric comorbidities such as mood, anxiety, trauma-related and personality disorders, have further showed to be strong predictors of poor treatment outcome in OUD, including lower rates of treatment retention and higher rates of relapse (Teoh Bing Fei, Yee, & Habil, 2016).
To date, only a limited number of studies have adequately investigated gender differences in OST population, although the number of women seeking treatment for opioid-related disorders has markedly increased since the 1960s, reaching amounts similar to men (Cicero, Ellis, Surratt, & Kurtz, 2014). Within this conceptual framework, a thorough re-evaluation of sex-related issues, along with a closer assessment of gender-specific psychopathological dimensions, have started to gain consistence in OUD management (Maremmani et al., 2010).
The aims of the present article were: (1) assessing psychopathological dimensions in an Italian sample of OUD individuals entering a methadone versus buprenorphine maintenance program; (2) evaluating possible gender-specific differences within the psychopathological profiles. Additional aims included the identification of variables that could be associated with psychopathology.
Section snippets
Subjects
Participants were included in the study if they were 18 years of age or older, currently meeting criteria for DSM-IV-TR opioid dependence disorder, attending an OST with methadone or buprenorphine, able to give written consent. Upon agreeing to participate in the study, subjects provided informed consent and underwent baseline assessment, which consisted of a structured clinical interview administered by trained research staff. We collected self-reported data on demographics, treatment
Socio-demographic and clinical characteristics
We recruited a total of 1052 participants receiving OST, consecutively admitted to 21 public addiction services in northern Italy between July and September 2014. Socio-demographic and clinical characteristics are summarized in Table 1.
Women were younger than men but this difference was not significant. Instead, significant differences have been found in terms of marital status, offspring, education and employment, with women being significantly more likely to be married, having children,
Discussion
The results of the current study reveal significant gender-specific differences in a real-world sample of opioid-maintained OUD individuals admitted to public addiction services in Italy. First, less than one-third (24.7%) of our sample included women. Although variations may occur depending on the type of OST, treatment setting and geographic location, usually rates of women attending opioid-related treatment rarely exceed 35%. Consistent with previous findings (Acharyya & Zhang, 2003), OUD
Role of funding sources
This paper was not funded.
Contributors
Authors Leone B and Di Nicola M designed the study and wrote the protocol. Author Moccia L conducted literature searches and provided summaries of previous research studies. Authors Leone B and Di Nicola M conducted the statistical analysis. Author Pettorruso M wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.
Conflict of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Acknowledgement
The authors would like to thank Dr. Isabella Panaccione for the expert revision of English Language.
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Both authors have equally contributed to this work.
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GICS (Gruppo InterSerD di Collaborazione Scientifica): Arzillo C., Bersani N., Bersani P., Biasin C., Bossi C., Bottazzo A., Bove A., Cantanchin F., Cantiero D., Canzian G., Cargnelutti D., Cibin M., De Cecco L., Dellantonio E., Dersini F., Fadelli M., Favero E., Fontana N., Franceschini A., Gaiga M., Gardiolo M., Gentile N., Ghezzo N., Giacomin MA., Manzato E., Mazzo M., Meneghello D., Mihalcea C., Milan E., Montresor M., Pani A., Pavani V., Resentera C., Residori M., Righetti P., Ripoli MA., Riscica P., Rizza C., Rizzetto V., Rossi A., Rovea A., Ruffato A., Ruzziconi C., Sembianti N., Smacchia C., Stimolo C., Zerbetto E., Zerman M.