Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

Abstract

Background and aims: Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses.Methods: Semi-annual cross-sectional interviews conducted in Oslo, Norway, (2006Norway, ( -2013, from 1,355 street-recruited IDUs. Hurdle, logistic, and multinomial regression models were employed.Results: Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. Conclusions:Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses.

Sykepleiere kan forebygge lekkasje av LAR-legemidler

“…LAR-legemidlene brukes illegalt for å oppnå eufori/ruseffekt, vanligvis som en del av blandingsmisbruk (5). Andre årsaker til illegal bruk er pris og tilgjengelighet (4) Ved slik selvmedisinering kan den illegale bruken ha noen positive effekter (4), og vaere mindre helseskadelig enn injisering for å oppnå ruseffekt (16). Lengre perioder med selvmedisinering utenfor substitusjonsbehandling kan også skyldes vanskeligheter med å forbli i behandling, ambivalens på grunn av kontrollrutiner i behandlingen eller stigmatisering fra andre i rusmiljøet (17).…”

Consumption of and satisfaction with health care among opioid users with chronic non‐malignant pain

“…Diversion and illicit use of opiate substitution drugs (OSD) appear to be widespread in countries where opioid substitution treatment (OST) is available. 5 Illicit OSD use is of public concern due to its potential health risks and because diversion to the black market may undermine public support and legitimacy of OST. 5 Bernard and colleagues utilized toxicological data linked with the Norwegian Cause of Death Registry and regional opioid maintenance treatment (OMT) registers, and identified 312 individuals who died after taking methadone from 2000 to 2006.…”

“…5 Illicit OSD use is of public concern due to its potential health risks and because diversion to the black market may undermine public support and legitimacy of OST. 5 Bernard and colleagues utilized toxicological data linked with the Norwegian Cause of Death Registry and regional opioid maintenance treatment (OMT) registers, and identified 312 individuals who died after taking methadone from 2000 to 2006. In 85% of these cases, the deceased had died of a methadone-related intoxication, most often in combination with other drugs, including benzodiazepines, cannabis, and other opioids.…”

Determination of drug residues in used syringe needles

“…The illegal use of diverted opioid substitution drugs, such as methadone and buprenorphine, is also common, both by oral and intravenous administration. 25 An increase in fentanyl-related deaths has been observed in the US and several European countries during the past decade. 26,27 This may be due to the use of fentanyl alone or street drugs, including heroin, adulterated with fentanyl.…”

“…About 30% had no permanent address or stayed at hostels; 85% had received social security payments or social assistance; 45% had earned money by selling drugs; and about 25% had engaged in criminal activity in the month leading up to the interview. 25 The aim of this pilot study was to examine whether the amounts of residual drugs in used needles were sufficient for drug testing and thus could become a useful supplement for monitoring drug use. We also wanted to explore whether it would be possible to distinguish between injected drug(s) and drugs present in residual blood traces in the injection needles.…”