Diversion of prescribed drugs by drug users in treatment: analysis of the UK market and new data from London

Fountain, Jane E.; Strang, John; Gossop, Michael; Farrell, Michael; Griffiths, Paul

doi:10.1046/j.1360-0443.2000.95339310.x

Cited by 104 publications

(74 citation statements)

References 49 publications

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“…A notable report in 1980 found evidence for addiction in only four of 11,882 patients, with no prior history of addiction, on narcotics for pain [13]. This finding has been supported by later studies [6] and by surveys of drug "diversion," showing that drugs sold on the street very rarely come from chronic pain sufferers [14]. However, prejudice and myth remain despite considerable experience and research suggesting that in appropriately selected patients, opioids have a low morbidity and low addiction potential [10,15].…”

Section: Cancer Pain and Addictionsupporting

confidence: 64%

Trust Violated: Analgesics for Addicts

et al. 2003

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Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members.Addiction among cancer patients on strong analgesics is a rare but difficult management challenge. The case is presented of a 28-year-old woman with breast cancer and painful bone metastases, suffering with dysfunctional social chaos and addicted to Percocet ® (oxycodone and acetaminophen). Having broken the trust of her health care team, trust was rebuilt by incorporating the substance abuse clinic and enforcing a contractual agreement. With open and honest support, the team was able to both care for and empower the patient. Issues of trust, liability, opioid tolerance, and barriers to optimal analgesia for cancer pain are discussed.

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Section: Cancer Pain and Addictionsupporting

confidence: 64%

Trust Violated: Analgesics for Addicts

et al. 2003

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“…It is well known that diversion of psychoactive prescription drugs involves original as well as falsified products and that diverted drugs have diverse origins, including personal prescriptions, drug theft, illegal Internet shopping as well as smuggling (Fischer et al, 2010;Fittler et al, 2013;Fountain et al, 2000;Inciardi et al, 2007;Lapyere-Mestre et al, 2014;Peirce et al, 2012;UN, 2014).…”

Section: Introductionmentioning

confidence: 99%

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Tjäderborn

Jönsson

Sandström

et al. 2016

Drug and Alcohol Dependence

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Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a confirmed intake of a psychoactive prescription drug, and to identify associated factors. Methods:Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was defined as a confirmed use of a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with nonprescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with nonprescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

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“…(9,26) Understanding methadone and buprenorphine diversion and its association with public health problems, as well as its connection with the drug abuse treatment process, is of considerable importance given the recent expansion of buprenorphine treatment in the U.S. and the sharp rise in methadone-related overdose deaths in the past few years. (27,28) Although there has been some recent epidemiological research concerning methadone diversion, (29) there has been limited ethnographic research since the work of Hunt and colleagues (30) more than two decades ago. Additionally, little is currently known regarding the uses of diverted buprenorphine or how it compares to the uses of diverted methadone.…”

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confidence: 99%

Uses of Diverted Methadone and Buprenorphine by Opioid‐Addicted Individuals in Baltimore, Maryland

et al. 2009

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This study examined the uses of diverted methadone and buprenorphine among opiate-addicted individuals recruited from new admissions to methadone programs and from out-of-treatment individuals recruited from the streets. Self-report data regarding diversion were obtained from surveys and semi-structured qualitative interviews. Approximately 16% (n=84) of the total sample (N=515) reported using diverted (street) methadone 2-3 times per week for six months or more, and for an average of 7.8 days (SD=10.3) within the past month. The group reporting lifetime use of diverted methadone as compared to the group that did not report such use was less likely to use heroin and cocaine in the 30 days prior to admission (ps < .01) and had lower ASI Drug Composite scores (p < .05). Participants in our qualitative sub-sample (n=22) indicated that street methadone was more widely used than street buprenorphine and that both drugs were largely used as self-medication for detoxification and withdrawal symptoms. Participants reported using low dosages and no injection of either medication was reported.

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Diversion of prescribed drugs by drug users in treatment: analysis of the UK market and new data from London

Abstract: The results suggest that, to be effective, diversion control must simultaneously involve deterrents from prescribers, drug treatment services, law enforcement agencies and dispensing pharmacists. Finally, some suggestions for further research on this under-studied issue are suggested.

Cited by 104 publications

References 49 publications

Trust Violated: Analgesics for Addicts

Trust Violated: Analgesics for Addicts

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Uses of Diverted Methadone and Buprenorphine by Opioid‐Addicted Individuals in Baltimore, Maryland

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