The DOI matches its Crossref record; 66 of the 66 references it cites were found in a registry or an index.
Opioid Use Disorder Comorbidity in Individuals With Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis
Abstract
ABSTRACT Background: Opioid use disorder (OUD) disproportionately affects individuals with schizophrenia, who are less likely to receive opioid agonist therapy (OAT) and have a poorer overall prognosis. To date, there is little specific clinical guidance in managing concurrent schizophrenia and OUD. Aims: We performed a systematic review to summarize the current literature regarding comorbid schizophrenia and OUD, estimate OUD comorbidity's prevalence in persons with schizophrenia and summarize the evidence around medication management of OUD in persons with schizophrenia. Methods: We searched 5 electronic databases for all experimental studies or quasi-experimental studies, randomized controlled studies using pharmacological interventions to treat OUD in individuals with concurrent psychosis and OUD and epidemiological studies measuring the prevalence of comorbid OUD in schizophrenia-spectrum disorders. We followed the PRISMA guidelines. Results: Our search strategy identified 491 records, from which 7 quasi-experimental designs and 19 observational designs met eligibility criteria. Most of the included studies explored the characteristics of OAT-receiving outpatients with schizophrenia versus those not diagnosed with schizophrenia. Most showed that the mean age of first psychiatric treatment was lower in the dually diagnosed and higher number of visits. However, there was no difference in OAT efficacy among patients with or without comorbid psychotic disorders. The meta-analyses for the lifetime and past-year prevalence of comorbid OUD among persons with schizophrenia were 5% and 2%, respectively. Conclusions: In the absence of clear evidence in the population of individuals with schizophrenia and comorbid OUD, following current guidelines for general adults remains the most evidence-based approach for this unique population. Contexte: Le trouble lié à l’usage d’opioïdes (TUO) affecte de manière disproportionnée les personnes atteintes de schizophrénie, qui sont moins susceptibles de recevoir un traitement d’agonistes opioïdes (TAO) et ont un pronostic global plus sombre. À ce jour, il existe peu d’orientations cliniques spécifiques dans la gestion de la schizophrénie concomitante et du TUO. Objectifs: Nous avons effectué une revue systématique afin de résumer la littérature actuelle concernant la schizophrénie comorbide et le TUO, estimer la prépondérance de la comorbidité du TUO chez les personnes atteintes de schizophrénie et résumer les preuves concernant la gestion médicamenteuse du TUO chez les personnes atteintes de schizophrénie. Méthodes: Nous avons effectué des recherches dans cinq bases de données électroniques pour toutes les études expérimentales ou quasi-expérimentales, les études contrôlées arbitraires utilisant des interventions pharmacologiques pour traiter le TUO chez les personnes atteintes de psychose concomitante et le TUO et les études épidémiologiques mesurant la prépondérance du TUO comorbide dans les troubles du spectre de la schizophrénie. Nous avons suivi les lignes directrices PRISMA. Résultats: Notre stratégie de recherche a identifié 491 enregistrements, parmi lesquels sept modèles quasi-expérimentaux et dix-neuf modèles d’observation répondaient aux critères d’éligibilité. La plupart des études incluses ont exploré les caractéristiques des patients ambulatoires recevant un TAO atteints de schizophrénie par rapport à ceux qui n’avaient reçu aucun diagnostic de schizophrénie. La plupart ont montré que l’âge moyen du premier traitement psychiatrique était plus tôt dans le cas du double diagnostic et le nombre de visites plus élevé. Cependant, il n’y avait pas de différence dans l’efficacité de traitement du TAO chez les patients avec ou sans troubles psychotiques comorbides. Les méta-analyses de la prépondérance au cours de la vie et au cours de l’année précédente du TUO comorbide chez les personnes atteintes de schizophrénie étaient respectivement de 5% et 2%. Conclusions: En l’absence de preuves claires dans la population d’individus atteints de schizophrénie et de TUO comorbide, suivre les lignes directrices actuelles fondées sur des études, pour les adultes en général, reste l’approche la plus recommandée pour cette population unique.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“evidence suggests a disproportionate impact of opioid use disorder (OUD) among individuals with schizophrenia”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [6]
In the citing paper
“who are less likely to receive opioid agonist therapy (OAT) and tend to have a poorer prognosis [6].”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [6]
Citations
Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164
Grant, B. F., Saha, T. D., Ruan, W. J., Goldstein, R. B., Chou, S. P., Jung, J., Zhang, H., Smith, S. M., Pickering, R. P., Huang, B., et al. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.2132 · Cited by 877
Review: Inequalities in healthcare provision for people with severe mental illness
Lawrence, D., & Kisely, S. (2010) · Journal of Psychopharmacology · doi:10.1177/1359786810382058 · Cited by 649
Barnes, T. R. E., Drake, R., Paton, C., Cooper, S. J., Deakin, J. F. W., Ferrier, I. N., Gregory, C. J., Haddad, P. M., Howes, O. D., Jones, I. R., et al. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119889296 · Cited by 615
Prevalence of Substance Abuse in Schizophrenia: Demographic and Clinical Correlates
Mueser, K. T., Yarnold, P. R., Levinson, D. F., Singh, H., Bellack, A. S., Kee, K., Morisson, R., & YADALAM, K. G. (1990) · Schizophrenia Bulletin · doi:10.1093/schbul/16.1.31 · Cited by 586
Management of opioid use disorders: a national clinical practice guideline
Bruneau, J., Ahamad, K., Goyer, M.-È., Poulin, G., Selby, P. L., Fischer, B., Wild, T. C., & Wood, E. (2018) · Canadian Medical Association Journal · doi:10.1503/cmaj.170958 · Cited by 412
The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update
(2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000633 · Cited by 412
Amato, L., Minozzi, S., Davoli, M., & Vecchi, S. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004147.pub4 · Cited by 379
Comorbidity of schizophrenia and substance abuse: Implications for treatment.
Mueser, K. T., Bellack, A. S., & Blanchard, J. J. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.60.6.845 · Cited by 315
The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal
Brissos, S., Veguilla, M. R., Taylor, D., & Balanzá-Martinez, V. (2014) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125314540297 · Cited by 297
Margolese, H., Malchy, L., Negrete, J., Tempier, R., & Gill, K. (2004) · Schizophrenia Research · doi:10.1016/s0920-9964(02)00523-6 · Cited by 277
A comparison of procedures to test for moderators in mixed-effects meta-regression models
Viechtbauer, W., López-López, J. A., Sánchez-Meca, J., & Marín-Martínez, F. (2015) · Psychological Methods · doi:10.1037/met0000023 · Cited by 241
Bahji, A., Mazhar, M. N., Hudson, C. C., Nadkarni, P., MacNeil, B. A., & Hawken, E. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.007 · Cited by 241
Self-citationSubstance use disorders in schizophrenia: review, integration, and a proposed model
Blanchard, J. (2000) · Clinical Psychology Review · doi:10.1016/s0272-7358(99)00033-1 · Cited by 240
Methadone at tapered doses for the management of opioid withdrawal
Amato, L., Davoli, M., Minozzi, S., Ferroni, E., Ali, R. L., & Ferri, M. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003409.pub4 · Cited by 229
Toftdahl, N. G., Nordentoft, M., & Hjorthøj, C. R. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1104-4 · Cited by 217
Pettersson, E., Larsson, H., & Lichtenstein, P. (2016) · Molecular Psychiatry · doi:10.1038/mp.2015.116 · Cited by 215
Psychotic symptom and cannabis relapse in recent-onset psychosis: Prospective study
Hides, L., Dawe, S., Kavanagh, D. J., & Young, R. M. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.bp.105.014308 · Cited by 166
Substance abuse in schizophrenia: a review.
Buckley, P. F. (1998) · PubMed · Cited by 161
The Public and the Opioid-Abuse Epidemic
Blendon, R. J., & Benson, J. M. (2018) · New England Journal of Medicine · doi:10.1056/nejmp1714529 · Cited by 159
Substance Misuse in Patients with Schizophrenia
Kavanagh, D. J., McGrath, J. J., Saunders, J. B., Dore, G. M., & Clark, D. (2002) · Drugs · doi:10.2165/00003495-200262050-00003 · Cited by 156
Buprenorphine for managing opioid withdrawal
Gowing, L., Ali, R. L., White, J. M., & Mbewe, D. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002025.pub5 · Cited by 156
Belbasis, L., Köhler, C. A., Stefanis, N. C., Stubbs, B., van Os, J., Vieta, E., Seeman, M. V., Arango, C., Carvalho, A. F., & Εvangelou, Ε. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12847 · Cited by 154
Rabinowitz, J., Bromet, E. J., Lavelle, J., Carlson, G. A., Kovasznay, B. M., & Schwartz, J. E. (1998) · Psychological Medicine · doi:10.1017/s0033291798007399 · Cited by 139
Bahji, A., Stephenson, C., Tyo, R., Hawken, E. R., & Seitz, D. P. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.2370 · Cited by 139
Self-citationNesvåg, R., Knudsen, G. P., Bakken, I. J., Høye, A., Ystrøm, E., Surén, P., Reneflot, A., Stoltenberg, C., & Reichborn‐Kjennerud, T. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1025-2 · Cited by 137
Crockford, D. N., & Addington, D. E. (2017) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717720196 · Cited by 113
Non-random relation between drugs of abuse and psychiatric diagnosis
McLellan, A. T., & Druley, K. A. (1977) · Journal of Psychiatric Research · doi:10.1016/0022-3956(77)90007-3 · Cited by 106
Demographic and clinical correlates of substance use disorders in first episode psychosis
Brunette, M. F., Mueser, K. T., Babbin, S. F., Meyer-Kalos, P., Rosenheck, R. A., Correll, C. U., Cather, C., Robinson, D. G., Schooler, N. R., Penn, D. L., et al. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.06.039 · Cited by 101
Martins, S. S., & Gorelick, D. A. (2011) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2011.05.010 · Cited by 93
Substance abuse in first-episode non-affective psychosis
Larsen, T. K., Melle, I. S., Auestad, B., Friis, S., Haahr, U., Johannessen, J. O., Opjordsmoen, S., Rund, B. R., Simonsen, E. H., Vaglum, P., et al. (2006) · Schizophrenia Research · doi:10.1016/j.schres.2006.07.018 · Cited by 92
Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline
Fairbairn, N. S., Ross, J. W. G., Trew, M., Meador, K., Turnbull, J., Macdonald, S., Oviedo‐Joekes, E., Foll, B. L., Goyer, M.-È., Perreault, M., et al. (2019) · Canadian Medical Association Journal · doi:10.1503/cmaj.190344 · Cited by 90
Comorbid Schizophrenia and Substance Abuse: A Review of Epidemiology and Course
Westermeyer, J. J. (2006) · American Journal on Addictions · doi:10.1080/10550490600860114 · Cited by 88
Schizophrenia and comorbid substance use disorder: effects of antipsychotics.
Green, A. I. (2005) · PubMed · Cited by 83
Dubertret, C., Bidard, I., Adès, J., & Gorwood, P. A. P. M. (2006) · Schizophrenia Research · doi:10.1016/j.schres.2006.05.006 · Cited by 82
Clinical characteristics influencing age at onset in psychotic disorders
Öngür, D., Lin, L. A., & Cohen, B. M. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.06.002 · Cited by 81
Mortality Among People With Opioid Use Disorder: A Systematic Review and Meta-analysis
Bahji, A., Cheng, B., Gray, S., & Stuart, H. L. (2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000606 · Cited by 77
Self-citationPatterns and Predictors of Substance use Disorders and Daily Tobacco use in First-Episode Psychosis
Wade, D., Harrigan, S., Edwards, J., Burgess, P., Whelan, G., & McGorry, P. (2005) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1080/j.1440-1614.2005.01699.x · Cited by 67
DSM-V Research Agenda: Substance Abuse/Psychosis Comorbidity
Rounsaville, B. J. (2007) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm054 · Cited by 62
Reduction in mortality risk with opioid agonist therapy: a systematic review and meta‐analysis
Bahji, A., Cheng, B., Gray, S., & Stuart, H. L. (2019) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13088 · Cited by 62
Self-citation[Cannabis and schizophrenia: demographic and clinical correlates].
Dervaux, A., Laqueille, X., Bourdel, M.-C., Leborgne, M.-H., Olié, J.-P., Löo, H., & Krebs, M. (2003) · PubMed · Cited by 61
Clinical Aspects of Substance Abuse in Persons with Schizophrenia
Negrete, J. C. (2003) · The Canadian Journal of Psychiatry · doi:10.1177/070674370304800104 · Cited by 59
Substance abuse and first‐episode schizophrenia‐spectrum disorders. The Danish OPUS trial
Petersen, L., Jeppesen, P., Thorup, A., Øhlenschlæger, J., Krarup, G., Østergård, T., Jørgensen, P., & Nordentoft, M. (2007) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2007.00015.x · Cited by 50
Basu, D., Sarkar, S., & Mattoo, S. K. (2012) · Journal of Dual Diagnosis · doi:10.1080/15504263.2012.749557 · Cited by 45
Histories of substance abuse in patients with postpsychotic depressions
Siris, S. G., Kane, J. M., Frechen, K. A., Sellew, A. P., Mandeli, J., & Fasano-Dube, B. (1988) · Comprehensive Psychiatry · doi:10.1016/0010-440x(88)90074-0 · Cited by 42
Association of Substance Use Disorders With Conversion From Schizotypal Disorder to Schizophrenia
Hjorthøj, C. R., Albert, N., & Nordentoft, M. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.0568 · Cited by 34
Gerra, G., Petta, G. D., d’Amore, A., Iannotta, P., Bardicchia, F., Falorni, F., Coacci, A., Strepparola, G., Campione, G., Lucchini, A., et al. (2007) · Clinical Neuropharmacology · doi:10.1097/wnf.0b013e31803354f6 · Cited by 32
Bahji, A., Carlone, D., & Altomare, J. (2019) · Addiction · doi:10.1111/add.14946 · Cited by 27
Self-citationLi, K. J., Chen, A., & DeLisi, L. E. (2020) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000593 · Cited by 25
Evidence for differential opioid use disorder in schizophrenia in an addiction treatment population
Chiappelli, J., Chen, S., Hackman, A. L., & Hong, L. E. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.05.004 · Cited by 23
Maremmani, A. G. I., Pallucchini, A., Rovai, L., Bacciardi, S., Spera, V., Maiello, M., Perugi, G., & Maremmani, I. (2018) · Annals of General Psychiatry · doi:10.1186/s12991-018-0185-3 · Cited by 21
Cannabis Use and Dependence among French Schizophrenic Inpatients
Lejoyeux, M., Basquin, A., Koch, M., Embouazza, H., Chalvin, F., & Ilongo, M. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00082 · Cited by 20
Protocols of Dual Diagnosis Intervention in Schizophrenia
Roncero, C., Barral, C., Grau‐López, L., Bachiller, D., Szerman, N., Casas, M., & Ruiz, P. (2011) · Addictive Disorders & Their Treatment · doi:10.1097/adt.0b013e318227ecdc · Cited by 20
Lamont, R., Rosic, T., Sanger, N., & Samaan, Z. (2020) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgaa007 · Cited by 19
Bahji, A., & Altomare, J. (2019) · doi:10.13140/rg.2.2.32063.25762 · Cited by 17
Self-citationComorbid opioid use is undertreated among forensic patients with schizophrenia
Kivimies, K., Repo‐Tiihonen, E., Kautiainen, H., & Tiihonen, J. (2018) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-018-0177-y · Cited by 13
Schizophrenia in high risk opioid users: A short communication on an autopsy study
Watkins, A. J., John, A. M., Bradshaw, C., Jones, J., & Jones, M. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.04.026 · Cited by 12
Rezansoff, S. N., Moniruzzaman, A., & Somers, J. M. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.05.031 · Cited by 11
Bruno, A., Romeo, V. M., Pandolfo, G., Scimeca, G., Zoccali, R. A., & Muscatello, M. R. A. (2013) · Substance Abuse · doi:10.1080/08897077.2013.814615 · Cited by 10
Maremmani, A. G. I., Bacciardi, S., Rovai, L., Rugani, F., Dell’Osso, L., & Maremmani, I. (2012) · Addictive Disorders & Their Treatment · doi:10.1097/adt.0b013e31824c5d1b · Cited by 6
Gimelfarb, Y., Shamir, E. Z., Dabush, K. N., & Ben-Tzarfati, M. (2020) · Journal of Addictive Diseases · doi:10.1080/10550887.2020.1782558 · Cited by 6
Bahji, A. (2019) · doi:10.13140/rg.2.2.27083.40480 · Cited by 5
Self-citationMethadone and buprenorphine treatments in patients with schizophrenia
Dervaux, A., Plancke, L., Amariei, A., Trouiller, P., Tahon, M., Martinetti, M. P., Naassïla, M., Cottencin, O., & Danel, T. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.05.013 · Cited by 4
Bouton, J. F., Laqueille, X., Bourdel, M., & Dervaux, A. (2017) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(17)31872-2 · Cited by 2
Cited by
Sorted by citations
Bahji, A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13040999 · Cited by 83
“Likewise, evidence suggests a disproportionate impact of opioid use disorder (OUD) among individuals with schizophrenia, who are less likely to receive opioid agonist therapy (OAT) and tend to have a poorer prognosis [6].”
BackgroundSelf-citationCavallotto, C., Chiappini, S., Mosca, A., d’Andrea, G., Carlo, F. D., Piro, T., Susini, O., Stefanelli, G., Cesare, A. D., Ricci, V., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13082206 · Cited by 20
Training in Substance use Disorders, Part 1: Overview of Clinical Practice Recommendations
Bahji, A., Crockford, D. N., Brasch, J. S., Schütz, C. G., Buckley, L., Danilewitz, M., Dubreucq, S., Mak, M. S. B., & George, T. P. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241231128 · Cited by 4
Self-citationLi, Y., Niemelä, S., & Denissoff, A. (2025) · Current Addiction Reports · doi:10.1007/s40429-025-00642-x · Cited by 4
Harm Reduction as an Essential Psychiatric Mental Health Nursing Skill
Kameg, B. (2025) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903251332641 · Cited by 2
Metadata
- Authors
- Danilewitz, M., & Bahji, A.
- Affiliations
- University of Toronto (CA)
- University of Calgary (CA)
- Venue
- Canadian Journal of Addiction
- Published
- 2021-12
- Volume
- 12
- Issue
- 4
- Pages
- 26-37
- ISSN
- 2368-4720 (ISSN-L)
- 2368-4739
- OpenAlex
- W4200034457
- Cited by
- 10
- References
- 66
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 2
- FWCI
- 0.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Canadian Journal of Addiction (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- opioid use disorder, schizophrenia, schizophrenia spectrum disorders, comorbidities, opioid substitution therapy, prevalence, dual diagnosis, medication management, psychosis, treatment outcomes, psychiatric comorbidity, treatment-seeking behavior, lifetime prevalence, medication adherence, treatment discontinuation, relapse
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
