Polysubstance use among patients receiving opioid agonist maintenance treatment in Belarus: source-dependent underreporting and implications for care
U. Pikirenia, Y. VolkauIntroduction
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