Non-prescribed use of substitution medication among German drug users—Prevalence, motives and availability

Abstract

BACKGROUND: Beyond unquestioned merits of opioid substitution treatment (OST), non-prescribed use of substitution medication (NPU) and its availability on the black market still constitute critical issues. METHODS: This cross-sectional study was conducted in low-threshold drug services in 13 German cities. Clients were interviewed face-to-face, using a structured questionnaire on drug use patterns, prevalence and motives for NPU, and availability and prices of substitution medication on the black market. RESULTS: Our sample of 753 drug users (74.5% male) had a mean age of 36.4 years, 42.4% were currently in OST and 78.4% reported heroin use in the past 30 days. NPU prevalence for lifetime, past 30 days, and past 24h was 66.7%, 25.8%, and 9.3%. Access to substitution medication was considered 'easy'. Injection of substitution medication was reported by 9.5% of our sample (i.e. 14.4% of injectors). Motives for NPU show large heterogeneity, with lack of other drugs and insufficient OST dosage as the reasons stated most frequently. CONCLUSIONS: NPU represents a relevant source of opiates among German drug users. While OST is associated with a reduction of illicit drug use and injection use, motives for NPU suggest that the treatment services do not sufficiently attract opioid-addicted persons. Language: en