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Dextromethorphan Abuse Among Opioid-Dependent Patients.

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Area of Science:

  • Psychiatry and Pharmacology
  • Addiction Medicine
  • Toxicology

Background:

  • Concomitant drug abuse is a significant issue in opioid-dependent patients undergoing maintenance therapy.
  • Dextromethorphan, an over-the-counter cough suppressant, has a high potential for misuse, particularly at elevated doses.
  • Opioid-dependent individuals may be more susceptible to dextromethorphan's effects due to its impact on serotonin levels, increasing risks of psychiatric symptoms and serotonin syndrome.

Purpose of the Study:

  • To investigate the prevalence of dextromethorphan abuse in opioid-dependent patients on maintenance therapy.
  • To compare subjective reports of abuse with objective laboratory findings.
  • To identify potential risk factors associated with dextromethorphan misuse in this population.

Main Methods:

  • A cross-sectional study involving 104 opioid-dependent patients in maintenance treatment.
  • Classification into dextromethorphan abusers (n=12) and nonabusers (n=92) based on 3-month hair toxicology analysis.
  • Statistical analysis using chi-squared, Student t, Mann-Whitney U, and Barnard exact tests.

Main Results:

  • Dextromethorphan abuse was identified in 11.5% of patients (12 individuals).
  • A significant proportion (91.7%) of abusers did not self-report dextromethorphan use, highlighting the utility of objective testing.
  • Dextromethorphan abusers showed significant differences in history of sexual maltreatment/violence, multiple traumas, and hallucinogenic drug use.

Conclusions:

  • Further research is needed on dextromethorphan's effects in patients with psychiatric comorbidities and those on psychiatric medication.
  • Dextromethorphan misuse poses a significant drug interaction risk, potentially leading to serotonin syndrome and psychiatric complications.
  • Active screening and testing for concomitant drug abuse are recommended for opioid-dependent patients to mitigate risks.