Use and diversion of illicit methadone – under what circumstances does it occur, and potential risks associated with continued use of other substances

Abstract

Background: Concerns about prescribed methadone diversion are ongoing. This research investigated motivations for methadone diversion and continued use of street-sourced substances. Methods: Questionnaires completed with 886 past year users of methadone recruited in and out of prescribing agencies. Topics covered included current prescribing, obtaining/providing methadone, reasons for using illicit methadone and other substance use. Results: Missing appointments (prescription pick-up or reviews) were the most common reasons for use of diverted methadone but the most common course of action in these circumstances was to use other street-sourced substances. Topping up dosage levels was also a common reason for obtaining illicit methadone. The most common reason diverting methadone was to “help another substance user out”. Concurrent and simultaneous use of a variety of substances whilst prescribed methadone was common. Conclusion: Reasons for using diverted methadone are primarily related to service use and provision. Treatment services will need to consider their role in reducing demand for diverted methadone. Unlike previous work the diversion of prescribed methadone appears to be most often motivated by altruism. Simultaneous and concurrent polysubstance use increases health risks, and with the extent of these risks not fully understood, individuals are “gambling” with their usage patterns.