Non-prescribed use of methadone and buprenorphine prior to opioid substitution treatment: lifetime prevalence, motives, and drug sources among people with opioid dependence in five Swedish cities

Johnson, Björn; Richert, Torkel

doi:10.1186/s12954-019-0301-y

Cited by 24 publications

(18 citation statements)

References 91 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, such non-prescribed use also involves substantial risks, as has been shown by this and other studies [15,17,36,59]. Since non-prescribed use is often driven by pseudotherapeutic motives [62], increased access to OST might decrease the illicit demand for these substances [60,61].…”

Section: Differences Between Deaths Caused By the Various Substances mentioning

confidence: 72%

Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Opioid-related deaths have increased in Western countries over recent decades. Despite numerous studies investigating opioid-related mortality, only a few have focused on the lives of the deceased individuals prior to their deaths, specifically regarding contact with care-providing authorities such as health, social and correctional services. Furthermore, a change has been noted in the last two decades as to which opioids cause most deaths, from heroin to prescription opioids. However, studies comparing fatalities caused by different substances are rare. The aim of this study was to investigate contact with care-providing authorities during the year prior to death among individuals who died as a result of opioid intoxication and to analyse differences relating to which opioids caused their deaths. Methods: The study is based on retrospective register data and includes 180 individuals with a history of illicit drug use, who died from opioid intoxication in Skåne, Sweden, between 1 January 2012 to 31 December 2013 and 1 July 2014 to 30 June 2016. Intoxications caused by heroin, methadone, buprenorphine and fentanyl were included. Data were collected from the National Board of Forensic Medicine, regional health care services, municipal social services and the Prison and Probation Service. Statistical testing was performed using Pearson's chi-square test, Fisher's exact test and the Mann-Whitney U test to analyse group differences. Results: A total of 89% of the deceased individuals had been in contact with one or more of the care-providing authorities during the year prior to death; 75% had been in contact with health care, 69% with the social services, 28% with the Prison and Probation Service, and 23% had been enrolled in opioid substitution treatment at some point during their final year of life. Few differences appeared between the substance groups with regard to which opioid contributed to the death. In addition to opioids, sedatives were present in more than 80% of the cases. Individuals whose deaths were buprenorphine-related had been in contact with the social services to a significantly lesser extent during the year prior to death. Conclusions: The studied population is characterised by extensive contact with care-providing authorities, thus providing numerous opportunities for authorities to reach this group with preventive and other interventions. Few differences emerged between groups with regard to which opioid had contributed to the death.

show abstract

Section: Differences Between Deaths Caused By the Various Substances mentioning

confidence: 72%

Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…As diversion of methadone is illegal and often leads to exclusion from OAT in Sweden, it is not surprising that police reports and other information do not capture this possible source. The majority of methadone prescriptions in Sweden are for SUD treatment [36] and a recent study in Sweden based on qualitative interviews of patients in OAT found a life‐time prevalence of non‐prescribed methadone use of 88% [37].…”

Section: Discussionmentioning

confidence: 99%

Methadone‐related deaths among youth and young adults in Sweden 2006–15

et al. 2020

View full text Add to dashboard Cite

Aims To identify methadone‐related deaths and determine the prevalence among youth and young adults in Sweden 2006–15. Design, Setting and Participants National retrospective registry study comparing data from all forensic autopsy examinations and toxicology cases involving methadone during 2006–15 in individuals aged 15–29 years with police records, previous pharmaceutical prescriptions and health‐care episodes. Measurements Multinomial logistic regression. To assess the factors contributing to the deaths, we compared individuals with and without previous substance use treatment and opioid use‐related diagnoses with regard to previous opioid agonist treatment (OAT), psychiatric care and previous pain medication. To assess the circumstances of deaths, we analyzed the presence of other drugs and other factors at time of death. Findings We identified 269 methadone‐related deaths, and the rate increased during the study period. Seventy‐two (27%) cases had not previously received substance use treatment, 112 (42%) had received treatment but had no opioid use‐related diagnosis and 85 (32%) had received treatment and had an opioid use‐related diagnosis. In total, only 10 individuals had been prescribed methadone during the year before death. Prescriptions of benzodiazepines (60%), antidepressants (62%) and opioids for pain (22%) the year before death were common. Most deaths occurred during sleep with a time lag from ingestion of methadone. Conclusion Prescription opioid‐ and methadone‐related deaths increased in the group aged 15–29 years in Sweden between 2006 and 2015. Exposure to non‐prescribed methadone and prescribed benzodiazepines, antidepressants and opioids for pain appears to be common in drug‐related deaths in youth and young adults in Sweden.

show abstract

“…Thus, concerns are still raised regarding the risks of misuse and diversion (Kenney, Anderson, Bailey, & Stein, 2017; Lin, Lofwall, Walsh, Gordon, & Knudsen, 2018; Mund & Stith, 2018). However, in many cases diversion is committed by opioid-dependent individuals to self-medicate in accordance with the legal purpose of buprenorphine (Bazazi, Yokell, Fu, Rich, & Zaller, 2011; Johnson & Richert, 2019). Additionally, non-medical use of buprenorphine is safer than methadone (Lee, Klein-Schwartz, Welsh, & Doyon, 2013).…”

Section: Buprenorphinementioning

confidence: 99%

Buprenorphine: prospective novel therapy for depression and PTSD

Madison

Eitan

2020

Psychol. Med.

View full text Add to dashboard Cite

BackgroundDepression and post-traumatic stress disorder (PTSD) are leading causes of disability and loss of life by suicide. Currently, there are less than satisfactory medical solutions to treat these mental disorders. Here, we explore recent preclinical and clinical studies demonstrating the potential of using buprenorphine to treat major depressive disorder, treatment-resistant depression, and PTSD.MethodBibliographic databases were searched to include preclinical and clinical studies demonstrating the therapeutic potential of buprenorphine and the involvement of the kappa opioid receptor (KOR) in mediating these effects.ResultsOriginal clinical studies examining the effectiveness of buprenorphine to treat depression were mixed. The majority of participants in the PTSD studies were males and suffer from chronic pain and/or substance use disorders. Nonetheless, these recent studies and analyses established proof of concept warranting farther investigations. Additionally, KOR likely mediates the antidepressant and some of the anxiolytic effects of buprenorphine. Still, it appears that the full spectrum of buprenorphine's beneficial effects might be due to activity at other opioid receptors as well.ConclusionsPharmaceuticals' abilities to treat medical conditions directly relates to their ability to act upon the endogenous biological systems related to the conditions. Thus, these recent findings are likely a reflection of the central role that the endogenous opioid system has in these mental illnesses. Further studies are necessary to study the involvement of endogenous opioid systems, and specifically KOR, in mediating buprenorphine's beneficial effects and the ability to treat these medical conditions while minimizing risks for misuse and diversion.

show abstract

Non-prescribed use of methadone and buprenorphine prior to opioid substitution treatment: lifetime prevalence, motives, and drug sources among people with opioid dependence in five Swedish cities

Cited by 24 publications

References 91 publications

Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances

Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances

Methadone‐related deaths among youth and young adults in Sweden 2006–15

Buprenorphine: prospective novel therapy for depression and PTSD

Contact Info

Product

Resources

About