The nature of methadone diversion in England: a Merseyside case study

Duffy, Paul; Baldwin, Helen

doi:10.1186/1477-7517-9-3

Cited by 35 publications

(48 citation statements)

References 60 publications

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“…There, 4% admitted to having shared, 2% to having sold, and 1% to having traded their methadone. 38 No study accounts for how great a proportion of the medication was diverted, but Spunt and colleagues categorized 10% of the patients as 'regular diverters'. 24 The research accounts for few demographic and treatment-related factors associated with selfreported diversion.…”

Section: 34mentioning

confidence: 99%

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Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Johnson

Richert

2014

Journal of Psychoactive Drugs

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BackgroundDiversion-patients who sell or share their medication-is a hotly debated but relatively unresearched phenomenon. We have investigated the prevalence of self-reported diversion of methadone and buprenorphine at OST programs in Sweden. We have also examined if demographic, treatment, and social factors can be associated with an increased risk of diversion. MethodsStructured interviews were conducted with 411 patients from eleven OST programs. A standardized questionnaire with 106 close-and five open-ended questions were used. 280 interviews were done on site, by the researchers, while 131 interviews were conducted by specially trained patients through privileged access interviewing. The data were analyzed through frequency-and averages-calculations, cross-tabulations, and logistic regression analysis. ResultsIn total, 24.1% (n=99) of the patients reported diversion in the past month. 67.6% (n=277) stated that they had diverted at some point. The peer interviews showed significantly higher levels of diversion (37.4% past month) compared with the researcher interviews (17.2%).Neither demographic factors, dosages, nor collection routines were associated with diversion.The likelihood of diversion was higher for patients on mono-buprenorphine (OR=5.64) and buprenorphine-naloxone (OR=2.10), than among methadone patients. Other factors which increased the likelihood of diversion were current illicit drug use (OR=5.60), having had 3 patients as a primary source of illicit methadone or buprenorphine prior to treatment (OR=3.39), and mainly socializing with active drug users (OR=2.12). ConclusionSelf-reported diversion was considerably higher than in previous studies. This is most likely due to the new methodological strategy we used, but may also partly be explained by low availability of OST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Efforts to decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, and expanded access to treatment, rather than on control measures.

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Section: 34mentioning

confidence: 99%

“…In our research review we have identified only five peer-reviewed cross-sectional studies 24,[35][36][37][38] (see Table 1). …”

Section: 34mentioning

confidence: 99%

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Johnson

Richert

2014

Journal of Psychoactive Drugs

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“…Previous studies on diversion have exclusively been based on interviews by researchers (Spunt et al 1986, Winstock et al 2008, Winstock and Lea 2010, Dale-Perera et al 2012, Duffy and Baldwin 2012, and have indicated that it is uncommon for OST patients to sell or share their medication-despite research showing that these substances are common among people who inject drugs (PWID) outside treatment (Obadia et al 2001, Lauzon et al 2002, Varescon et al 2002, Humeniuk et al 2003, Davis and Johnson 2007, Håkansson et al 2007, Vlahov et al 2007, Yokell et al 2011, Schmidt et al 2013. We assumed that this paradox could be the result of under-reporting of some forms of self-reported data.…”

Section: Introductionmentioning

confidence: 96%

A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment

Johnson

Richert

2016

Addiction Research & Theory

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Aims: Privileged Access Interviewing (PAI) has traditionally been used to reach illicit drug users and other 'hidden' populations. How PAI data compare to other self-reported data has seldom been discussed. We compare data from patients in opioid substitution treatment (OST), gathered through PAI and researcher interviews, respectively, to investigate whether PAIs and researchers are reaching comparable populations, and whether differences in answers are due to the sensitive nature of the questions.Methods: Structured interviews were conducted with 368 patients from nine OST clinics in three Swedish cities. 237 interviews were carried out by researchers, and 131 by nine PAIs (OST patients). Data were analyzed with χ 2 test, Fisher's exact test, t-test, and logistic regression analysis.Results: PAIs and researchers recruited comparable populations, with few differences in terms of individual, treatment, and social factors. However, self-reported behaviors revealed several significant differences. Alcohol consumption and drinking to intoxication was more commonly reported among patients interviewed through PAI (p<0.001 and p=0.001, respectively). Furthermore, the PAI group reported selling medication (p<0.001 last month, p<0.001 during treatment episode), and snorting buprenorphine (p=0.010 last month, p=0.001 during treatment episode) more frequently.Conclusions: PAI is a useful method in studies of illicit drug use and a valuable complement to more traditional interviewing methods. Specifically as regards revelations of a sensitive or controversial nature, PAI seems to produce different results than researcher interviews, and possibly also more truthful responses. PAI may have considerable potential as a datagathering method also when studying other, more easily accessible populations.

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“…For this reason, there is an argument for stricter OST regimens, including supervised OSD intake and restriction of take-home doses (Obadia et al, 2001). However, less flexible regimens may result in fewer treatment seekers and lower retention rates (Duffy et al, 2012;Pani et al, 1996). This in turn could have serious public health implications given the health risks among opioid users and OST's contribution to the reduction of such risks (Clausen et al, 2008;Darke et al, 2011;Degenhardt et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Diversion and illicit use of opiate substitution drugs (OSD), such as methadone and buprenorphine, appear to be widespread in countries where opioid substitution treatment (OST) is available (Duffy et al, 2012;Roche et al, 2008;Winstock et al, 2009). 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.…”

Section: Introductionmentioning

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

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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.

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The nature of methadone diversion in England: a Merseyside case study

Cited by 35 publications

References 60 publications

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment

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

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