Abstract
BackgroundOpioid substitution treatment (OST) with methadone or buprenorphine is the most effective means of treating opioid dependence. If these substances are used by people who are not undergoing OST, they can however carry serious risks. This article examines the lifetime prevalence, motives, and drug sources for such use, as well as geographical differences in these variables.MethodsStructured interviews were conducted with 411 patients from 11 OST clinics in five Swedish cities. The researchers carried out 280 interviews on-site, while 131 interviews were conducted by specially trained patients through privileged access interviewing. Data were analyzed by frequency and average calculations, cross-tabulations, and χ2 tests.ResultsThe lifetime prevalence of non-prescribed use was 87.8% for methadone, 80.5% for buprenorphine, and 50.6% for buprenorphine/naloxone. Pseudo-therapeutic motives—avoiding withdrawal symptoms, staying clean from heroin, detoxification, or taking care of one’s own OST—were commonly cited as driving the use, while using the drugs for euphoric purposes was a less common motive. Most respondents had bought or received the substances from patients in OST, but dealers were also a significant source of non-prescribed methadone and buprenorphine. Geographical differences of use, motives, and sources suggest that prescription practices in OST have a great impact on which substances are used outside of the treatment.ConclusionsExperiences of non-prescribed use of methadone and buprenorphine are extremely common among those in OST in southern Sweden. As the use is typically driven by pseudo-therapeutic motives, increased access to OST might decrease the illicit demand for these substances. Buprenorphine/naloxone has a lower abuse potential than buprenorphine and should therefore be prioritized as the prescribed drug. Supervised dosage and other control measures are important provisions in the prevention of drug diversion and non-prescribed use among people not undergoing OST.
Highlights
Opioid substitution treatment (OST) with methadone or buprenorphine is the most effective means of treating opioid dependence
The use of methadone (87.8%) and buprenorphine (80.5%) is very common in the population, while the use of buprenorphine/naloxone (50.6%) is not quite as common. This is probably because buprenorphine/naloxone had only been used for a few years in Sweden at the time of the interviews and that it was not prescribed at the clinics to a similar extent as methadone and buprenorphine
As regards the experience of involuntary discharge, there are no differences. This suggests that the decision to seek OST is generally preceded by the non-prescribed use of methadone, buprenorphine, and buprenorphine/naloxone
Summary
Opioid substitution treatment (OST) with methadone or buprenorphine is the most effective means of treating opioid dependence. If these substances are used by people who are not undergoing OST, they can carry serious risks. This article examines the lifetime prevalence, motives, and drug sources for such use, as well as geographical differences in these variables. Opioid substitution treatment (OST) with methadone or buprenorphine (including buprenorphine/naloxone) is considered the most effective means of treating opioid dependence. Methadone and buprenorphine are safe and effective when used according to the prescription [5, 6] If they are used improperly (in a way contravening the prescription) or by people who are not undergoing OST, these substances can carry serious risks. If the substances are injected, the risks are similar to those of injected heroin, including overdose, life-threatening infections, and transmission of blood-borne diseases [7, 8]
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