Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Johnson, Björn; Richert, Torkel

doi:10.1016/j.drugpo.2014.10.003

Cited by 46 publications

(49 citation statements)

References 43 publications

(35 reference statements)

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“…estimates are higher in populations of substance abusers compared to estimates in the general population (127,144,145); for misuse compared to abuse, and abuse compared to prescription drug use disorder (123, 140); for non-fatal compared to fatal abuse-related outcomes (110); for composite endpoints compared to single measures (69); and for strong opioid analgesics and benzodiazepines compared to other prescription drugs (131,146). However, conflicting data exist and the true prevalence of misuse and abuse is largely unknown.…”

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 88%

“…This is supported by data showing a dramatically increasing trafficking of prescription drugs (original drugs diverted from early stages of the distribution process, or counterfeit drugs) from other countries (138). A proportion of illegal prescription drugs are also reported to be diverted from the health care system (137,143,144), but there is a lack of reliable data.…”

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

“…Linked to this, previous medical use of psychoactive prescription drugs is an important predictor of subsequent misuse, and misuse, in turn, is an important predictor of subsequent abuse (165). A history of using medications with addictive properties (such as opioid analgesics), or of disorders requiring such medications (including chronic pain), as well as previous substance abuse, substance use disorder or drug-related crime are all associated with prescription drug abuse in many studies (116,144,166).…”

Section: Factors Associated With Psychoactive Prescription Drug Use Dmentioning

confidence: 99%

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Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

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Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognised and emerging public health concerns. Aim:The aim of this thesis is to estimate the occurrence and prevalence of psychoactive prescription drug use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods:A study using register data from forensic cause of death investigations analysed and described cases of fatal unintentional intoxications with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were scrutinized and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming intake of tramadol, diazepam, flunitrazepam, zolpidem and zopiclone, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a national cohort of patients initiating prescribed treatment with pregabalin, identified using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use above the maximum approved daily dose (MAD) of the drug, and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, in which tramadol was judged to have caused or contributed to the death. Of the deceased, more were men, the median age was 44 years and the majority used multiple psychoactive substances (prescription drugs, alcohol and/or illicit drugs). In the second study, 104 spontaneously vi reported cases of possible or probable tramadol dependence were identified, of which more concerned women. The median age in these cases was 45 years and in about a third of cases the person had a history of substance abuse and in 40% of cases there was documented history of psychoactive medication use. Severe addiction was reported. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription.Non prescribed use was most frequent in users of benzodiazepines and of tramadol compared to users of zolpidem or zopiclone, and was more likely in younger individuals and in multiplesubstance users and less likely in individuals with a recent prescription for another psychoactive medication. In the last paper, five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of use of doses above the maximum approved daily dose. The highest risk of use of daily doses above the MAD over time was associated with male sex, younger age, non-urban residency, and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions

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Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 88%

Section: Pharmacoepidemiological Methods In Studies Of Psychoactive Pmentioning

confidence: 99%

Section: Factors Associated With Psychoactive Prescription Drug Use Dmentioning

confidence: 99%

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Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Tjäderborn

2016

Linköping University Medical Dissertations

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“…It is important to carefully monitor the use of illicit drugs and diversion of the medications for opioid treatment to other users. 43 Although, theoretically, any long-acting oral opioid might be used for maintenance, the only approved drugs for this use in the United States are methadone and buprenorphine.…”

Section: Opioid Maintenance Approachesmentioning

confidence: 99%

Treatment of Opioid-Use Disorders

Benumof

2016

N Engl J Med

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“…However, there is little evidence that high levels of supervision and control are directly related to a decrease in misuse and diversion [32,47] . Misuse of diverted maintenance medication is more frequent in countries with poor treatment access (e.g.…”

Section: Impact Of Treatment Conditions and Rulesmentioning

confidence: 99%

Opioid Maintenance Treatment - A Call for a Joint European Quality Care Approach

Brandt¹,

Unger²,

Moser

et al. 2015

Eur Addict Res

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Aims: The aim of this exploratory analysis of European Quality Audit of Opioid Treatment data was to identify areas of improvement for current opioid maintenance treatment (OMT) approaches. Methods: Factors facilitating treatment entry, retention and refusal were compared between 8 European countries and between OMT patient (OMT-P) and active opioid user (AOU) sample groups. Both groups were divided into those who had never had OMT before (un-experienced OMT-P (n = 573) and AOU (n = 360)) and those who had been maintained at least once prior to this investigation (experienced OMT-P (n = 746) and AOU (n = 377)). Results: The European comparison showed that motives for starting OMT vary distinctly between countries (p ≤ 0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p ≤ 0.05). Conclusion: Increasing awareness of potential shortcomings of OMT delivery systems is crucial to optimally match treatment approaches to patient needs and also to reduce the considerable economic burden of addiction to society.

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Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Cited by 46 publications

References 43 publications

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

Treatment of Opioid-Use Disorders

Opioid Maintenance Treatment - A Call for a Joint European Quality Care Approach

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