The Potential Role of Long-Acting Injectable Antipsychotics in People With Schizophrenia and Comorbid Substance Use

Abstract

Objective: Treatment of schizophrenia in patients with comorbid substance use (alcohol/illicit drug use, abuse, or dependence) presents challenges for public health systems. Substance use in people with schizophrenia is up to four times greater than the general population and is associated with medication nonadherence and poor outcomes. Therefore, continuous antipsychotic treatment in this population may pose more of a challenge than for those with schizophrenia alone. Many clinical trials and treatment recommendations in schizophrenia do not take into consideration substance use, as people with comorbid substance use have typically been excluded from most antipsychotic trials. Nonetheless, antipsychotic treatment appears to be as efficacious in this population, although treatment discontinuation remains high. The objective of this review was to highlight the importance and utility of considering long-acting injectable antipsychotics for patients with schizophrenia and comorbid substance use. Methods: We did a literature search using PubMed with keywords schizophrenia and substance use/abuse/dependence, nonadherence, antipsychotics, long-acting injectables, relapse, and psychosocial interventions. We limited our search to human studies published in English and 4,971 articles were identified. We focused on clinical trials, case reports, case series, reviews, and meta-analyses, resulting in 125 articles from 1975 to 2011. Results: Our review suggests the potential role of long-acting injectables for people with comorbid substance use and schizophrenia in leading to improvements in psychopathology, relapse prevention, fewer rehospitalizations, and better outcomes. Conclusions: While more research is needed, long-acting antipsychotics should be considered an important option in the management of cases of schizophrenia and comorbid substance use.

Keywords:

• substance use
• nonadherence
• long-acting antipsychotics
• relapse
• drug abuse

ACKNOWLEDGMENTS

We thank Drs. David Gorelick, Robert McMahon, and Eric Slade for editing a few sections of the manuscript. The work was supported in part by the NIMH funded T32 grant MH067533-07 (PI: William Carpenter) and NIDA contract N01DA59909 (PI: Deanna Kelly).