The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible

Carroll, Jennifer; Rich, Josiah D.; Green, Traci C.

doi:10.1097/adm.0000000000000436

Cited by 68 publications

(49 citation statements)

References 22 publications

(27 reference statements)

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“…National data from 2018 indicated that only 42 % of substance use treatment facilities offered medications for OUD ( U.S. Substance Abuse and Mental Health Services Administration, 2019 ). As well, significant waitlists for buprenorphine providers continue to block access to such medications across the U.S. ( Carroll et al, 2018b ; Fox et al, 2015 ; Parran et al, 2017 ). Given these ongoing challenges in the larger healthcare system, it is reasonable to hypothesize that first responders are recognizing (and emotionally responding to) the population effects of insufficient treatment capacity in their own line of work.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose

Carroll

Mital

Wolff

et al. 2020

Drug and Alcohol Dependence

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Highlights Most patrol officers who respond to OD calls receive training and carry naloxone. One in three officers report making an arrest at an OD scene in the past 6 months. A minority of officers correctly described their state’s Good Samaritan Law. Officer endorsement of OD-prevention strategies decreases as OD response increases.

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Section: Discussionmentioning

confidence: 99%

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose

Carroll

Mital

Wolff

et al. 2020

Drug and Alcohol Dependence

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“…Inaccessibility may force heroin-dependent patients who require prescription methadone, but are unable to consistently visit these centers, to purchase it illicitly ( Carroll, Rich & Green, 2018 ). In Israel, OMT and in-patient centers are usually located in industrial areas in the periphery of cities with limited hours of operation.…”

Section: Discussionmentioning

confidence: 99%

The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users

Shapira

Rosca

Berkovitz

et al. 2020

PeerJ

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Background Substitution can be defined as the consciously motivated choice to use one drug, either licit or illicit, instead of another, due to perceptions of cost, availability, safety, legality, substance characteristics, and substance attributions. Substitution represents a potential risk to drug users, mainly when substitutes are of higher potency and toxicity. This study offers a basic conceptualization of illicit substitution behavior and describes substitution patterns among users of two highly prevalent drugs of abuse—heroin and cannabis. Methods Here, 592 high-risk drug users undergoing pharmacological and psycho-social treatment were interviewed. Patients were asked questions about current drug use, lifetime substitution, and substitution patterns. Descriptive statistics, chi-square tests of independence, and multinomial logistic regressions were used to identify and test correlates of substitution patterns for heroin and cannabis. Results Of the 592 drug users interviewed, 448 subjects (75.7%) reported having substituted their preferred drug for another illicit substance. Interviews yielded a total of 275 substitution events reported by users of cannabis, and 351 substitution events reported by users of heroin. The most frequently reported substitution substances for responders who preferred heroin were illicit non-prescribed “street” methadone (35.9%), followed by oral and transdermal prescription opioids (17.7%). For responders who preferred cannabis, substitution for synthetic cannabinoid receptor agonists (33.5%) followed by alcohol (16.0%) were the most commonly reported. Age at onset–of–use (p < 0.005), population group (p = 0.008), and attending treatment for the first time (p = 0.026) were significantly associated with reported lifetime substitution. Past-year use of stimulants, heroin, hallucinogens, methylenedioxymethamphetamine (MDMA), and novel psychoactive substances were—at the 95% confidence level—also significantly associated with reported lifetime substitution. In multivariate analysis, the odds for methadone substitution among heroin users were significantly affected by age at onset-of-use, type of treatment center, and education. Odds for substitution for synthetic cannabinoid receptor agonists among cannabis users were significantly affected by age, population group, type of treatment center, and education. Conclusion Self-substitution behavior should be considered by clinicians and policymakers as a common practice among most drugusers. Substitution for street methadone provides evidence for the ongoing diversion of this substance from Opioid Maintenance Treatment Centers, while the prominence of substitution of synthetic cannabinoids among dual-diagnosis patients should be regarded as an ongoing risk to patients that needs to be addressed by clinicians. Analysis of additional substitution patterns should provide further valuable insights into the behavior of drugusers.

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“…These medications (e.g. buprenorphine, methadone) may be misused either alone or in combination with other drugs, to attain euphoria and/or reduce cravings or withdrawal symptoms induced by opioids [ 21 – 24 ]. Literature reviews have shown that the burden of diversion and misuse of opioid substitution medications includes poor adherence to recommended treatment which negatively impacts treatment outcomes, excess of mortality, somatic complications associated with injecting drug use (e.g.…”

Section: Introductionmentioning

confidence: 99%

The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic

Mravčík¹,

Janíková²,

Drbohlavová³

et al. 2018

Harm Reduct J

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Opioid agonist therapy (OAT) has been available in a standard regime in the Czech Republic since 2000. Buprenorphine is the leading medication, while methadone is available only in a few specialised centres. There is an important leakage of buprenorphine onto the illicit market, and the majority of Czech opioid users are characterised by the misuse (and injecting) of diverted buprenorphine medications. Most prescribed buprenorphine for OAT is not covered by current national health insurance schemes, and patients have to pay considerable prices to afford their treatment. This affordability barrier together with limited accessibility is likely the leading factor of limited coverage of OAT and of recent stagnation in the number of patients in the official treatment programmes in the Czech Republic. It also encourages doctor shopping and the re-selling of parts of their medication at a higher price, which represents the main factor that drives the Czech illicit market for buprenorphine, but at the same time co-finances the medication of clients in official OAT programmes. Improving access to OAT by making it financially affordable is essential to further increase OAT coverage and is one of the factors that can reduce the illicit market with OAT medications.

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The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible

Abstract: The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.

Cited by 68 publications

References 22 publications

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose

Knowledge, preparedness, and compassion fatigue among law enforcement officers who respond to opioid overdose

The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users

The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic

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