Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 15:12:808002.
doi: 10.3389/fpsyt.2021.808002. eCollection 2021.

Long-Acting Injectable Antipsychotic Treatment in Schizophrenia and Co-occurring Substance Use Disorders: A Systematic Review

Alexandria S Coles  1 , Dunja Knezevic  1 , Tony P George  1   2 , Christoph U Correll  3   4   5 , John M Kane  3   5 , David Castle  1   2
Affiliations

Long-Acting Injectable Antipsychotic Treatment in Schizophrenia and Co-occurring Substance Use Disorders: A Systematic Review

Alexandria S Coles et al. Front Psychiatry. .

Abstract

Objectives: Co-occurring substance use disorders (SUDs) among individuals with schizophrenia are a prevalent and complex psychiatric comorbidity, which is associated with increased symptom severity, worsened illness trajectory and high rates of treatment non-adherence. Recent evidence suggests that the use of long-acting injectable (LAI) antipsychotics may provide an effective treatment option for individuals with this dual-diagnosis. Methods: A systematic review of the literature was conducted using the databases PubMed, PsychInfo and Google Scholar for English-language studies, investigating the use of LAIs in co-occurring schizophrenia and substance use disorders (SCZ-SUDs). Results: Eight reports [one case study (n = 1), one case series (n = 8), three open-label retrospective studies (n = 75), and three randomized controlled trials (n = 273)] investigated the use of LAI antipsychotics in 357 participants with SCZ-SUDs [alcohol use disorder: 5 studies, n = 282; cocaine use disorder: 5 studies, n = 85; amphetamine use disorder: 1 study, n = 1; cannabis use disorder: 3 studies, n = 160; opioid use disorder: 3 studies, n = 19; methylenedioxymethamphetamine (MDMA) use disorder: 2 studies, n = 9; ketamine use disorder: 1 study, n = 4] and were included in this systematic review. Findings indicate significant improvements in substance use related outcomes across 7 of 8 studies, while in 6 of 8 studies, significant improvements in psychopathology-related outcomes were reported. Conclusions: LAI antipsychotics may be an efficacious intervention option for the treatment of SCZ-SUDs. However, varying methodological rigor, generally small sample sizes and heterogeneity of samples, settings, substances of abuse, tested LAIs and comparators, as well as psychosocial cotreatments and level of reported detail across studies requires that these findings be considered preliminary and interpreted with caution. Further research is required to better understand the effects of LAIs among individuals with SCZ-SUDs.

Keywords: antipsychotic; long acting injectable (LAI); schizophrenia; substance use disorder (SUD); treatment.

PubMed Disclaimer

Conflict of interest statement

CC has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Axsome, Damitsa, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Janssen/J & J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Relmada, Rovi, Seqirus, Servier, SK Life Science, Sumitomo Dainippon, Sunovion, Supernus, Takeda, Teva, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Relmada, Rovi, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of LB Pharma. DC has received grant monies for research from Eli Lilly, Janssen Cilag, Roche, Allergen, Bristol-Myers Squibb, Pfizer, Lundbeck, Astra Zeneca, Hospira; Travel Support and Honoraria for Talks and Consultancy from Eli Lilly, Bristol-Myers Squibb, Astra Zeneca, Lundbeck, Janssen Cilag, Pfizer, Organon, Sanofi-Aventis, Wyeth, Hospira, Servier, Seqirus; and is a current or past Advisory Board Member for Lu AA21004: Lundbeck; Varenicline: Pfizer; Asenapine: Lundbeck; Aripiprazole LAI: Lundbeck; Lisdexamfetamine: Shire; Lurasidone: Servier; Brexpiprazole: Lundbeck; Treatment Resistant Depression: LivaNova; Cariprazine: Seqirus. He is a founder of the Optimal Health Program OHP, currently operating as Optimal Health Australia, which holds the IP for OHP; is part owner of Clarity Healthcare. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Prisma consort diagram.
See this image and copyright information in PMC

References

    1. Moore E, Mancuso SG, Slade T, Galletly C, Castle DJ. The impact of alcohol and illicit drugs on people with psychosis: the second Australian national survey of psychosis. Aust N Z J Psychiatry. (2012) 46:864–78. 10.1177/0004867412443900 - DOI - PubMed
    1. Hunt GE, Large MM, Cleary M, Lai HM, Saunders JB. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990–2017: systematic review and meta-analysis. Drug Alcohol Depend. (2018) 191:234–58. 10.1016/j.drugalcdep.2018.07.011 - DOI - PubMed
    1. Covino M, Di Nicola M, Pepe M, Moccia L, Panaccione I, Lanzotti P, et al. . Predictors of clinical severity in subjects attending the emergency department for substance use: a ten-year cross-sectional study. Am J Emerg Med. (2021) 49:287–90. 10.1016/j.ajem.2021.06.022 - DOI - PubMed
    1. Bennett ME, Bradshaw KR, Catalano LT. Treatment of substance use disorders in schizophrenia. Am J Drug Alcohol Abuse. (2017) 43:377–90. 10.1080/00952990.2016.1200592 - DOI - PubMed
    1. Crockford D, Addington D. Canadian schizophrenia guidelines: schizophrenia and other psychotic disorders with coexisting substance use disorders. Can J Psychiatry. (2017) 62:624–34. 10.1177/0706743717720196 - DOI - PMC - PubMed

Publication types

LinkOut - more resources