Is opioid substitution treatment beneficial if injecting behaviour continues?

Gjersing, Linn; Bretteville-Jensen, Anne Line

doi:10.1016/j.drugalcdep.2013.05.022

Cited by 25 publications

(22 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Those currently in treatment, despite continued IVDU, had significantly fewer non-fatal overdoses (O.R.=0.5), committed fewer thefts (O.R.=0.6) and reported dealing drugs (O.R.=0.7) less often in the prior month. They were also less likely to use heroin daily or near daily (O.R.=0.3) compared to the other groups that were not in treatment (Gjersing and Bretteville-Jensen, 2013). This does not imply that physicians must accept and do nothing about medication misuse and diversion or that they should continue to prescribe buprenorphine to patients who are distributing it to others rather than taking it themselves.…”

Section: Recommended Practice Behaviors To Deter Misuse and Diversionmentioning

confidence: 96%

A Review of Buprenorphine Diversion and Misuse

Lofwall

Walsh

2014

Journal of Addiction Medicine

208

109

View full text Add to dashboard Cite

Outpatient opioid addiction treatment with sublingual buprenorphine pharmacotherapy (OBOT) has rapidly expanded in the United States and abroad, and, with this increase in medication availability, there have been increasing concerns about its diversion, misuse and related harms. This narrative review defines the behaviors of diversion and misuse, examines how the pharmacology of buprenorphine alone and in combination with naloxone influence its abuse liability, and describes the epidemiological data on buprenorphine diversion and intravenous misuse, risk factors for its intravenous misuse and the unintended consequences of misuse and diversion. Physician practices to prevent, screen for, and therapeutically respond to these behaviors, which are a form of medication non-adherence, are discussed and gaps in knowledge are identified. OBOT experiences from other countries that have varied health care systems, public policies, and access to addiction treatment are shared in order to make clear that diversion and misuse occur across the world in various contexts, for many different reasons, and are not limited to buprenorphine. Comparisons are made with other opioids with known abuse liability as well as medications with no known abuse. The objective is to facilitate understanding of diversion and misuse so that all factors influencing their expression (patient and provider characteristics and public policy) can be appreciated within a framework that also recognizes the benefits of addiction treatment. With this comprehensive perspective, further careful work can help determine how to minimize these behaviors without eroding the current benefits realized through improved addiction treatment access and expansion.

show abstract

Section: Recommended Practice Behaviors To Deter Misuse and Diversionmentioning

confidence: 96%

A Review of Buprenorphine Diversion and Misuse

Lofwall

Walsh

2014

Journal of Addiction Medicine

208

109

View full text Add to dashboard Cite

show abstract

“…Although OST is an effective treatment, some individuals receiving OST continue injecting substances and use a number of other substances as well as the substitute, and remain at risk of overdose, potentially even from the substitute itself [4,10,11]. As one example, a long-term study of heroin users recruited via participation in a methadone maintenance programme found that half the sample was deceased after the 30 years of study, while more than 50% of those remaining had used heroin consistently.…”

Section: Introductionmentioning

confidence: 99%

“…overdose and injecting injuries) and to the public (e.g. criminal behaviours), but ongoing harmful drug use is a continuing concern and the major sign of treatment failure [4,10]. Despite the fact that the majority of adult PWID are polysubstance users, and some OST clients continue injecting, there is limited research on how OST relates to polysubstance use profiles among PWID and whether these impact upon drug-related outcomes [1,10].…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we use latent class analysis (LCA) to: (i) test whether or not polysubstance use profiles are invariant between two groups of PWID, those receiving and not receiving OST for at least 6 months; and then (ii) compare associations among the resulting classes on a range of drug-related outcomes. We add to previous studies investigating the role of OST in reducing drug-related harms and criminal behaviours in individuals who persist to inject drugs [10] by incorporating further differences among these two groups due to polysubstance use profiles. Importantly, we do not aim to assess whether treatment reduces polysubstance use and associated harms as this is not possible with our cross-sectional data, which are drawn from a sample of PWID who inject regularly.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Differences in polysubstance use patterns and drug‐related outcomes between people who inject drugs receiving and not receiving opioid substitution therapies

et al. 2016

View full text Add to dashboard Cite

Polysubstance use profiles exhibiting a broad range of substance use were generally at increased risk of negative drug-related outcomes, whether or not participants were receiving OST, including thrombosis among OST receivers [odds ratio (OR) = 2.13, 95% confidence intervals (CI) = 1.09-4.17], injecting with used needles among OST receivers and non-receivers, respectively (OR = 2.78, 95% CI = 1.50-5.13; OR = 2.15, 95% CI = 1.34-3.45) and violent criminal offences among OST receivers and non-receivers, respectively (OR =2.30, 95% CI = 1.16-4.58; OR = 1.87, 95% CI = 1.14-3.07). An important exception was non-fatal overdose which was related specifically to a class of PWID who were not receiving OST and used morphine frequently (OR = 1.83, 95% CI = 1.06-3.17) CONCLUSION: Regardless of opioid substitution therapies usage, people who inject drugs who use a broad-range of substances experience greater levels of injecting-related injuries and poorer health outcomes and are more likely to engage in criminal activity than other groups of people who inject drugs.

show abstract

“…Therefore, we reported the findings based on the entire sample. Please see (Gjersing & Bretteville-Jensen, 2013) for more information on the effects of possible duplicates.…”

Section: Data Analysesmentioning

confidence: 99%

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

Bretteville-Jensen¹,

Lillehagen²,

Gjersing³

et al. 2015

Drug and Alcohol Dependence

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Is opioid substitution treatment beneficial if injecting behaviour continues?

Cited by 25 publications

References 31 publications

A Review of Buprenorphine Diversion and Misuse

A Review of Buprenorphine Diversion and Misuse

Differences in polysubstance use patterns and drug‐related outcomes between people who inject drugs receiving and not receiving opioid substitution therapies

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

Contact Info

Product

Resources

About