Abstract
Background
Opioid substitution treatment (OST) is an evidence-based intervention but concerns persist regarding diversion of prescribed medication. This study assessed the prevalence of and motivating factors behind OST medication diversion and acquisition of illicit OST medication self-reported by persons treated within OST programs or needle exchange services in Birmingham, UK.
Methods
In total, 511 clients in OST programs and 105 people using needle exchange services completed anonymous questionnaires consisting of 25 open and closed questions. Logistic regression analysis was used to explore associations between OST diversion and acquisition of illicit OST medication.
Results
Of the 511 clients, 32.5% (n=166) self-reported diversion at some point and 37.4% (n=62) had diverted at least once a week; 25.2% (n=25.2%) reported current diversion. Diversion was largely altruistic. The likelihood of diversion was higher for clients currently using illicit drugs (OR=3.59) and not taking the full dose of OST; those reporting side effects as the reason were the most likely to divert (OR 3.07, p=0.021). Comparing There was no difference between the proportion diverting methadone (103/401 or 25.7%) and buprenorphine (26/104 or 25%) . The odds ratio of diverting methadone relative to buprenorphine was 1.28 (95% CI 0.75 to 2.20), which was not statistically significant. Acquisition of OST was common (63.6%, n=325), was highly associated with illicit drug use (OR 2.79, p=0.003) and longer duration in treatment.
Conclusion
Rates of diversion and acquisition of OST medication were high but consistent with previous European studies. The predictors offer important clues to reduce these activities, and point to the importance of optimised OST medication with awareness of diversion potential, side effect profile, and effective supervision.
Opioid substitution treatment (OST) is an evidence-based intervention but concerns persist regarding diversion of prescribed medication. This study assessed the prevalence of and motivating factors behind OST medication diversion and acquisition of illicit OST medication self-reported by persons treated within OST programs or needle exchange services in Birmingham, UK.
Methods
In total, 511 clients in OST programs and 105 people using needle exchange services completed anonymous questionnaires consisting of 25 open and closed questions. Logistic regression analysis was used to explore associations between OST diversion and acquisition of illicit OST medication.
Results
Of the 511 clients, 32.5% (n=166) self-reported diversion at some point and 37.4% (n=62) had diverted at least once a week; 25.2% (n=25.2%) reported current diversion. Diversion was largely altruistic. The likelihood of diversion was higher for clients currently using illicit drugs (OR=3.59) and not taking the full dose of OST; those reporting side effects as the reason were the most likely to divert (OR 3.07, p=0.021). Comparing There was no difference between the proportion diverting methadone (103/401 or 25.7%) and buprenorphine (26/104 or 25%) . The odds ratio of diverting methadone relative to buprenorphine was 1.28 (95% CI 0.75 to 2.20), which was not statistically significant. Acquisition of OST was common (63.6%, n=325), was highly associated with illicit drug use (OR 2.79, p=0.003) and longer duration in treatment.
Conclusion
Rates of diversion and acquisition of OST medication were high but consistent with previous European studies. The predictors offer important clues to reduce these activities, and point to the importance of optimised OST medication with awareness of diversion potential, side effect profile, and effective supervision.
| Original language | English |
|---|---|
| Journal | Heroin Addiction and Related Clinical Problems |
| Publication status | Published - Feb 2017 |