Characteristics of retention and survival of lifetime pathological gambling in methadone maintenance treatment.

BACKGROUND

Pathological gambling is prevalent among methadone maintenance treatment patients. We aimed to study their long-term retention and survival which have not yet been studied.

METHODS

Between 2006 and 2014, 350 patients in an MMT clinic were assessed for lifetime probable pathological gambling (PG) using the South Oaks Gambling Screen questionnaire. Their retention in MMT and survival up to June/2024 were analyzed using the Kaplan-Meier and Cox model. Vital data were obtained from a national registry.

RESULTS

PG was identified in 60(17.1 %) patients. They had a higher male proportion (83.3 % vs. 65.2 %, p = 0.006). They were older at MMT entry (42.2 ± 9.5 vs. 38.6 ± 9.6, p = 0.007), had longer duration of opioid use, and an earlier cannabis onset, but had comparable opioid onset (22.5 ± 6.8) and were similar in the proportion of urine screened positive substances at MMT admission. The PG had shorter cumulative retention since the first admission and until the latest admission (13.1 years, 95 %CI 11.1-15.2) than the non-PG (17.2 years, 95 % CI 15.9-18.4, p = 0.009), also when excluding deaths during MMT (p = 0.013). Survival since admission to MMT was shorter in PG (19.2y, 95 %CI 16.9-21.5 vs. 24.4y 95 %CI 23.2-25.5, p < 0.001); however, with no difference by age at death observed.

CONCLUSIONS

The PG group is characterized as males who were admitted to MMT at an older age following longer opioid usage duration. The PG failed to adhere to MMT; they dropped out, had shorter survival, although they did not die younger. Additional follow-up and specific intervention to improve their outcome are recommended.