Diversion of opioid maintenance treatment medications and predictors for diversion among Finnish maintenance treatment patients.
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.
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.
Essiina
E
Launonen
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.
Hannu
H
Alho
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.
Elina
E
Kotovirta
Department of Applied Health Research, University College London, Torrington Place, London WC1E 7HB, UK.
Isla
I
Wallace
Clinicum, University of Helsinki and Helsinki University Hospital, PO Box 63, FI-00014 Helsinki University, Finland; A-Clinic Foundation, Maistraatinportti 2, 00240 Helsinki, Finland.
Kaarlo
K
Simojoki
D000328:Adult; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D064226:Prescription Drug Diversion / Q000706:statistics & numerical data*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D055815:Young Adult
D000069479:Buprenorphine, Naloxone Drug Combination; D008691:Methadone
Abuse; Buprenorphine; Diversion; Methadone; Opioid maintenance treatment; Substance use