EPP141 - Polysubstance use among patients receiving opioid agonist maintenance treatment in Belarus: source-dependent underreporting and implications for care

EPP141

Polysubstance use among patients receiving opioid agonist maintenance treatment in Belarus: source-dependent underreporting and implications for care

U. Pikirenia ^1,*, Y. Volkau ²

¹Substance Use Disorders Department, Psychiatric Hospital in Frombork, Frombork, Poland, ²Low threshold services, NGO "Positive Movement", Minsk, Belarus

 

Introduction: Opioid agonist maintenance treatment (OAMT) reduces mortality and HIV-related harms, yet concurrent substance use remains common and undermines outcomes. Robust estimates are essential for service planning and overdose prevention.

Objectives: To quantify recent substance use among OAMT patients in Belarus, compare prevalence by data-collection route, and examine associations with treatment characteristics.

Methods: Cross-sectional survey (February – March 2021) of OAMT patients using an anonymised questionnaire. Substances queried: nicotine, alcohol (light/strong), cannabinoids, synthetic cathinones, amphetamines, off-label sedatives/hypnotics (benzodiazepines, Z-drugs), anticholinergics (e.g., diphenhydramine), opioids, and synthetic cannabinoids. Recency of last use was coded ordinally (day→>12 months/never). Data were collected via three routes: online, peer consultants, or clinic staff. Descriptives, χ² tests (with ε²), Spearman correlations, and t-tests were used (α=0.05). Only anonymised records were analysed.

Results: N=199 (mean age 41.3 years; ~57% male). In the previous year, 87.9% used nicotine (85.9% daily), 62.2% light alcohol, 46.9% sedatives/hypnotics, 44.1% strong alcohol, 21.6% cannabis, 19.3% anticholinergics, 18.1% synthetic cathinones, 9.9% opioids, 8.0% amphetamines, and 0.5% synthetic cannabinoids.
The mean number of substance groups used in 12 months differed by collection route: online 3.8, peer 3.5, staff 1.8 (χ²=44.53, df=2, p<0.0001, ε²=0.24); for illegal substances: 1.6, 1.5, 0.4 (χ²=40.72, df=2, p<0.0001, ε²=0.22).
Longer OAMT duration correlated with fewer substance groups in the last year (ρ=−0.203, p=0.007) and fewer illegal substances (ρ=−0.242, p=0.001). No differences by methadone vs buprenorphine or by prescribed dose.
Gender differences were found for cannabis (men 30.6% vs women 9.1%) and opioids (men 19.1% vs women 2.1%; p=0.006).

Conclusions: Polysubstance use, especially nicotine, alcohol, sedatives/hypnotics, and synthetic cathinones, is prevalent among Belarusian OAMT patients, but prevalence is substantially under-reported when disclosures are made to clinic staff. Findings support non-punitive, confidential assessment pathways (online/peer-mediated), routine screening for sedatives and alcohol, targeted harm-reduction/overdose prevention, and tobacco harm-reduction support. Sustained engagement with OAMT appears protective against broader substance involvement; services should prioritise retention while addressing polysubstance risks.

 

Disclosure of Interest: None Declared