Trends in substance use over 31 years in a large methadone maintenance treatment (MMT) clinic in Israel

The opioid epidemic and evolving circumstances occurred over the last 30 years. We aimed to study substance use over 3 decades in a large methadone maintenance treatment (MMT) facility within a tertiary-referral medical center and compare characteristics of patients between 3 time points, 10 years apart.

The prevalence of substance use was determined monthly between 1993 and 2024 based on observed random urine tests. A comparison of characteristics of current patients in January 2004, 2014, and 2024 were analyzed.

The proportion of females decreased from 27 % to 20 %, and the age of admission rose from 37 to 43, but with no difference in the age of opioid use onset. The proportion of 'ever' drug injected, hepatitis C and B slightly reduced, significantly so, if patients who were at more than one time point were excluded. Over the years, cocaine misuse increased, and benzodiazepines remained high with a slight reduction. The opioid misuse rate was low and stable, cannabis was low but somewhat elevated, and amphetamines were very low to the point that their monitoring was infrequently.

While the good news is that drug injection, and infectious diseases are reduced over time, the increase in cocaine and cannabis is worrying, as well as the trend of older age when entering MMT, even though the age of opioid onset does not change. These trends are discussed along with potential explanations.