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Addictive Behaviors

Impact of Suicidality on Cocaine Use Outcomes among Adults in Methadone Maintenance Treatment

(PS6-D89) Impact of Suicidality on Cocaine Use Outcomes Among Adults in Methadone Maintenance Treatment

Saturday, November 19, 2022

9:00 AM – 10:00 AM EST

Location: Westside Ballroom, 5th Floor

Author(s)

Lourah M. Kelly, Ph.D.

Clinical Research Associate
University of Connecticut
West Hartford, Connecticut

Co-Author(s)

SA

Sheila Alessi, Ph.D.

Associate Professor
University of Connecticut
Farmington, CT, Connecticut
Carla Rash, Ph.D.

Associate Professor
UConn Health
Farmington, Connecticut
KZ

Kristyn Zajac, Ph.D.

Associate Professor
University of Connecticut
Farmington, CT, Connecticut

Background: Concurrent stimulant and opioid misuse contributes to significant mortality and morbidity, representing a deadly “fourth wave” of the opioid epidemic in the US (Jenkins, 2021). Persons with cocaine and opioid use disorders are at high risk for suicidality (i.e., suicidal ideation, attempts; Han et al., 2018; Harford et al., 2018), yet little is known about rates of suicidality among persons stabilized on methadone for opioid use disorder. Contingency management (CM) is efficacious regardless of baseline psychological distress (Weinstock et al., 2007). However, since CM does not directly address suicidality, it is possible that suicidality may dampen outcomes for CM. This study aims to 1) elucidate risk factors for suicidality among persons in methadone maintenance treatment who present with cocaine use disorder, and 2) evaluate whether suicidality at baseline dampens cocaine use outcomes, and 3) evaluate whether suicidality dampens such outcomes differentially in CM+Standard Care (SC) vs SC alone.

Methods: Data were from five randomized controlled trials (N = 560) comparing 12-weeks of SC plus CM primarily targeting cocaine use to SC alone within methadone clinics. Suicidality was self-reported as none (56.4%), past suicidal ideation (SI; 11.1%), recent (i.e., past month) SI (3.6%), and lifetime suicide attempts (28.9%; only 2 persons reported past month suicide attempts).

Results: At baseline, suicidality groups differed by gender, employment status, past month income, trauma history, and psychosocial functioning. Persons with lifetime suicide attempts reported greater years of polysubstance use, previous drug treatments, and unintentional overdose history. For substance use outcomes, persons with past SI reported longer durations of cocaine abstinence than persons with no suicidality. Suicidality by condition interactions on substance use outcomes were not significant, though there were within-group differences. In CM+SC, people with past SI reported longer durations of cocaine abstinence and those with lifetime suicide attempts reported greater proportion negative cocaine screens than those with no suicidality.

Conclusions: Within this sample of adults receiving methadone treatment, persons with lifetime suicide attempts reported high rates of polysubstance use problems and unintentional overdose. The few differences in cocaine use outcomes showed improved success for persons with past SI and lifetime suicide attempts within CM+SC. Floor effects may have masked suicidality group differences by condition, as SC participants achieved low durations of abstinence and proportion negative screens. High rates of suicidality indicate that methadone clinics could be key points of entrance into mental health care for persons with suicide risk.