Abstract
Background'Non-compliant’ individuals in opioid maintenance treatment, OMT, are often met with tight control regimes to reduce the risk of 'diversion’, which may lead to harm or death among persons outside of OMT. This article explores reported practices of, and motivations for, diversion of methadone and buprenorphine, in a group of imprisoned individuals in OMT.Findings28 in-depths interviews were conducted among 12 OMT-enrolled, imprisoned individuals, most of whom were remand prisoners. All had experienced tight control regimes prior to imprisonment due to varying degrees of 'non-compliance’ and illicit drug use during treatment. Their acquired norm of sharing with others in a drug using community was maintained when entering OMT. Giving one’s prescription opioids to an individual in withdrawal was indeed seen as an act of helping, something that takes on particular significance for couples in which only one partner is included in OMT and the other is using illicit heroin. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. ’Diversion’, as this term is conventionally used, is not typically understood as practices of giving and helping, but may nevertheless be perceived as such by those who undertake them.ConclusionsAs we see it, the need to sustain oneself as a decent person in one’s own eyes and those of others through practices such as sharing and helping should be recognized. Treatment providers should consider including couples in which both individuals are motivated for starting OMT.
Highlights
Background: ‘Non-compliant’ individuals in opioid maintenance treatment, Opioid maintenance treatment (OMT), are often met with tight control regimes to reduce the risk of ‘diversion’, which may lead to harm or death among persons outside of OMT
Treatment providers should consider including couples in which both individuals are motivated for starting OMT
While only one of the project participants reported regularly selling or exchanging his methadone for heroin, several individuals had developed strategies to prevent themselves from selling their prescription opioids
Summary
The need to sustain oneself as a decent person in one’s own eyes and those of others through practices such as sharing and helping should be recognized. While only one of the project participants reported regularly selling or exchanging his methadone for heroin, several individuals had developed strategies to prevent themselves from selling their prescription opioids Among these were: avoiding potential buyers by taking alternatives routes to and arriving late at the pharmacy, maintaining a secretive status as OMT-patients and asking family members for help with monetary problems. In contrast to Mona and her partner, Simon was among those who found a situation in which only one partner was enrolled in OMT to be an impossible one Before entering treatment, he had had a partner who was addicted to heroin and was clear about his opinion that a relationship in which one partner is in treatment and one dependent on illegal drugs involves unsolvable and unbearable moral dilemmas: you have to come up with ways [to give away your medication] to help your girlfriend if she is having a bad day. You're off to hell of a bad start if you can't both get help [treatment], together
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