Drug treatment practitioners’ perceptions of methadone diversion and their responses to it

Abstract

Aim: Methadone maintenance treatment (MMT) is a key treatment for opiate addiction; however, concerns about the diversion of methadone remain. Further empirical data on methadone diversion are required to inform clinical decisions. This study examined drug treatment practitioners’ perceptions of the illicit methadone market in Merseyside, England, and responses to it.Method: Semi-structured interviews with 120 practitioners directly involved in the delivery of MMT. Interview topics included: perceptions of the extent, nature and impact of diversion; protocols for prescribing and dispensing; and measures to prevent diversion. Local guidelines for prescribing and dispensing were obtained.Findings: Participants perceived methadone to be diverted in small amounts for monetary gain or shared among partners, friends and family. Illicit methadone was felt to be used to ‘top up’, replace prescriptions or self-medicate if not in treatment. Supervised consumption was thought to be the only effective way to prevent diversion.Conclusion: Findings provide an insight into illicit methadone's use in the community. Additional research with opiate users is required to determine their views on measures to prevent diversion. While agencies are required to take steps to prevent diversion, it is felt to be inevitable and is tolerated to a certain degree in the pursuit of harm reduction.