Predictive factors of persisting illicit drug use in hospitalized heroin addicts

The efficacy of methadone treatment in reducing the rate of positive urinalyses for opiates has been repeatedly assessed in outpatient intravenous heroin users (IHUs), but not in IHUs hospitalized for coexisting diseases. The aim of the present study, performed on 83 IHUs, was to assess the rate of drug-free urinalyses for addictive drugs over a 13-day period of hospitalization. The rate of drug-free urinalyses was then related to the intensity of withdrawal symptoms, the level of dependence (as measured by the severity of dependence scale (SDS)) and of heroin craving (as measured by a visual analogical scale, (VAS)), assessed on admission and on days 4, 7, 10, and 13. All but nine patients received methadone upon hospitalization. The results show that positive urinalyses for morphine and/or cocaine dropped over the period of observation from 67 to 7%. On admission, patients who persisted in the illicit use of heroin did not differ significantly from the rest in terms of abstinence scores or daily methadone dose, but scored higher at the SDS and yielded urinalyses which all tested positive for morphine and/or cocaine. In conclusion, in the hospital setting low methadone doses (32.5 mg per die on average) induce a drug-free condition in the majority of patients and high SDS scores associated with positive urinalysis for morphine and/or cocaine are predictive of persistent drug abuse during hospitalization.