Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients

Essiina Launonen; Hannu Alho; Elina Kotovirta; Isla Wallace; Kaarlo Simojoki

doi:10.1016/j.drugpo.2015.03.007

Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients

Int J Drug Policy. 2015 Sep;26(9):875-82. doi: 10.1016/j.drugpo.2015.03.007. Epub 2015 Apr 1.

Authors

Essiina Launonen¹, Hannu Alho², Elina Kotovirta³, Isla Wallace⁴, Kaarlo Simojoki⁵

Affiliations

¹ Clinicum, University of Helsinki and Helsinki University Hospital, PO Box 63, FI-00014 Helsinki University, Finland; University of Eastern Finland, School of Medicine, Faculty of Health Sciences, P.O. Box 1627, FI-70211 Kuopio, Finland. Electronic address: essiina.launonen@helsinki.fi.
² Clinicum, University of Helsinki and Helsinki University Hospital, PO Box 63, FI-00014 Helsinki University, Finland; National Institute of Health and Welfare, Department of Mental and Substance Abuse Services, P.O. Box 30, FI-00271 Helsinki, Finland.
³ Ministry of Social Affairs and Health, Department for Promotion of Welfare and Health, Unit for Harm Prevention, P.O. Box 33, FI-00023 Government, Finland.
⁴ Department of Applied Health Research, University College London, Torrington Place, London WC1E 7HB, UK.
⁵ Clinicum, University of Helsinki and Helsinki University Hospital, PO Box 63, FI-00014 Helsinki University, Finland; A-Clinic Foundation, Maistraatinportti 2, 00240 Helsinki, Finland.

PMID: 25934054
DOI: 10.1016/j.drugpo.2015.03.007

Abstract

Background: Diversion (i.e. selling or giving away) of opioid maintenance treatment (OMT) medications is a challenge that concerns many units providing OMT worldwide and tools for prevention are needed. The object of this study was to examine the prevalence and predictors for diversion of the OMT medications buprenorphine-naloxone (BNX) and methadone (MET) among Finnish OMT patients.

Methods: A cross-sectional study was conducted among all Finnish OMT patients of whom 60% (n=1508) participated. The data were collected by anonymous questionnaires distributed through all OMT units in Finland. To evaluate predictors for diversion, we used binominal regression analysis with unadjusted and adjusted ORs. Selling and/or giving away of OMT medication was used as a dependent variable and explanatory variables were gender, age, duration of OMT, type of OMT medication and dose, dispensation method of OMT medication, place of residence and intravenous use of any intoxicating drugs during the past six months.

Results: Of all 1508 respondents, 7% (n=100) had sold and 12% (n=169) had given their OMT medication to others, 57% for money and 23% in exchange for other drugs. In multivariate analysis, predictors associated with diversion were BNX as OMT medication (OR 2.76, 95% CI 1.76-4.33), low (<9.0mg/day) BNX dose (OR 1.74, 95% CI 1.01-2.98), intravenous use of intoxicating drugs during the past six months (OR 4.48, 95% CI 3.13-6.43) and increasing length of OMT (OR 1.01, 95% CI 1.01-1.02). Age, place of residence or unsupervised pharmacy distribution of BNX were not associated with diversion.

Conclusions: In order to reduce diversion, more interventions are needed to support patients to stop concurrent substance abuse. Increasing control measures, for example, increased supervision, are unlikely to prevent diversion. Given that sub-optimal dosing of BNX increases the risk of diversion, more attention should be paid to providing patients with an optimal medical dose.

Keywords: Abuse; Buprenorphine; Diversion; Methadone; Opioid maintenance treatment; Substance use.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Buprenorphine, Naloxone Drug Combination / administration & dosage
Cross-Sectional Studies
Female
Finland
Humans
Male
Methadone / administration & dosage
Middle Aged
Multivariate Analysis
Opiate Substitution Treatment / methods*
Opioid-Related Disorders / drug therapy*
Prescription Drug Diversion / statistics & numerical data*
Regression Analysis
Surveys and Questionnaires
Young Adult

Substances

Buprenorphine, Naloxone Drug Combination
Methadone