Background

Accumulating evidence shows that some antidepressants are abused for their psychostimulant effects, but the extent of antidepressants abuse is unknown in subjects with opioid use disorders (OUD).

Objectives

To assess the prevalence of antidepressant abuse and its correlates in subjects with OUD.

Methods

Subjects ≥ 18 year-old in an opiate maintenance treatment (OMT) program who reported using an antidepressant were selected from the OPPIDUM program from 2011 to 2020. The outcome was antidepressant abuse. Antidepressant abusers were identified as subjects reporting at least one of the following behaviors: “drug abuse”, “concomitant use of alcohol”, “illegal obtaining”, and “dose higher than recommended in the Summary of Product Characteristics”.

Results

Among the 83 040 observations of subjects ≥ 18 year-old in an OMT program included in the OPPIDUM program from 2011 to 2020, 2708 (3.3%) subjects reported using an antidepressant in monotherapy. Among them, there were 385 (14.2%) abusers. The proportion of abusers was the highest for amitriptyline (n = 31, 25.0%). In multivariate analysis, antidepressant abuse was positively associated with amitriptyline (OR 2.09, 95% CI [1.14, 3.85]; p = 0.017), no professional activity (OR 1.52, 95% CI [1.15, 2.01]; p = 0.003), the use of intravenous route of administration (OR 1.78, 95% CI [1.11, 2.77]; p = 0.013), and the use of benzodiazepines (OR 1.51, 95% CI [1.19, 1.93]; p <0.001).

Conclusion

Clinicians should be aware of the risk of antidepressant abuse when prescribing in subjects with OUD, accounting for their heterogeneous pharmacological properties that may account for their abuse potential.