Name: Nikhita Singhal
Supervisors: Dr. Zainab (Zena) Samaan
Education Program and Level: Undergraduate MD program, Year 2
As a second-year medical student, I have had the privilege of meeting patients, staff physicians, residents, and allied health professionals who have fueled my passion to pursue a career in psychiatry. Though I initially gravitated toward this specialty based on my interest in mental health and a fascination with the perceived dichotomy between mind and body, various experiences along my educational trajectory have intensified my desire to work in the field.
Being able to collaborate with peers in the Psychiatry Interest Group to encourage exposure to this specialty and plan educational events has been incredibly rewarding, as has exploring various facets of mental illness through research projects under Dr. Samaan’s supervision. Working with excellent mentors has been invaluable, and I hope to continue challenging the stigma that shrouds this area of medicine as I strive for a career as a psychiatrist involved in both clinical practice and research!
Opioids, a class of analgesic medications commonly prescribed to treat moderate to severe chronic pain, are known to have a high potential for abuse and addiction. Examples include morphine, codeine, hydrocodone, oxycodone, hydromorphone, and fentanyl, among others. Unfortunately, an increase in the availability and use of opioids has led to an upsurge in the prevalence of opioid use disorder (OUD) in Canada and is causing an epidemic-like number of overdose deaths across the country.
OUD is characterized as a problematic pattern of opioid use leading to clinically significant impairment or distress; this may involve increased tolerance, repeated withdrawal symptoms, and sustained behavioural changes. The most commonly used intervention for patients with OUD is opioid substitution therapy (OST) with substances such as buprenorphine or methadone. In Canada, the most frequently used OST is methadone as a form of harm reduction through methadone maintenance treatment (MMT). MMT involves the supervised prescription of methadone, a long-acting synthetic opioid agonist, in order to alleviate withdrawal symptoms in dependent patients and reduce drug-seeking behaviour.
Although MMT is an effective treatment for OUD, there is a significant degree of inter-individual variability in treatment outcomes and side effects — including comorbid substance use. GENOA (Genetics of Opioid Addiction), a prospective research collaborative between the Canadian Addiction Treatment Centre and McMaster University’s Population Genomics Program, was conceived to address these differences and the biological, psychological, and social factors which may influence them. With data from over 1500 patients in MMT programs, it seeks to investigate a variety of predictors of treatment outcomes.
In a previous study from the GENOA project, polysubstance use was reported to be a significant issue in MMT. Polysubstance use during MMT is particularly concerning for increased risk of opioid overdose and death. Of the current studies that investigate polysubstance use in MMT, most focus on the impact of polysubstance use on MMT outcomes — such as ongoing illicit opioid use — rather than factors influencing concurrent reductions in the use of non-opioid substances. Although methadone was not intended to reduce substance use other than opioids, preliminary evidence may support its usefulness in this area.
Recognizing the importance of identifying useful interventions in the current opioid crisis to minimize health risks, the goal of my project was to examine change in comorbid non-opioid substance use, and the demographic and clinical factors associated with these changes, among patients on MMT for OUD. Using demographic and clinical data from 597 participants, we found a significant decrease in use of alcohol and cannabis between baseline and 12 months, with a significant association between increasing age and decreasing alcohol use.
Encouragingly, these findings suggest that patients on MMT for OUD may experience concomitant reductions in non-opioid substance use. This could have implications for both health and social outcomes. Determining other key factors associated with these reductions could have a significant impact on clinical thinking regarding polysubstance use in MMT and treatment outcomes, and we hope that future studies will aim to investigate this.
Read Nikhita’s abstract here.
For the full abstract listing from Research Day 2018, visit our Research Events page.