title: Methods and motivations for buprenorphine diversion from public opioid substitution treatment clinics.
abstract: This study aimed to develop a better understanding of the motives for suspected buprenorphine diversion during supervised dosing. Structured interviews were conducted with clients after 71 episodes of diversion at 3 opioid substitution treatment clinics in Sydney, Australia. Interviews were conducted by the clinic manager. An equivalent number of suspected episodes involved diversion via removal of buprenorphine from the mouth (n = 35), and secretion of buprenorphine in the mouth (n = 32). Denial of diversion occurred in 45% of suspected episodes and was significantly associated with secretion of buprenorphine in the mouth (P < .0001), suggesting a possible misunderstanding between clinicians and clients to what constitutes diversion. Motivations for diversion included "stockpiling" for later sublingual use (n = 15), discarding buprenorphine (n = 11), and giving it to another person (n = 5). A consistent definition of diversion of supervised dosed of buprenorphine is required. Diversion of supervised doses may represent a single episode of nonadherence to dosing instructions or more significant ambivalence over treatment. Responses to suspected diversion should aim to minimise harm and maximise treatment outcomes.
authors.affiliation: Drug Health Services, Sydney South West Area Health Service, New South Wales, Australia. adam winstock@hotmail.com
authors.forename: Adam R
authors.initials: AR
authors.lastname: Winstock
authors.forename: Toby
authors.initials: T
authors.lastname: Lea
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Jackson
mesh_terms: D000284:Administration, Oral; D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009294:Narcotics / Q000008:administration & dosage*; D009517:New South Wales; D009293:Opioid-Related Disorders / Q000523:psychology* / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers; D055815:Young Adult
chemical_list: D009294:Narcotics; D002047:Buprenorphine