title: Factors associated with non-adherence and misuse of opioid maintenance treatment medications and intoxicating drugs among Finnish maintenance treatment patients.
abstract: BACKGROUND
  The intravenous (IV) use of opioid maintenance treatment (OMT) medications and other intoxicating drugs among OMT patients is a challenge for many OMT units and affects treatment outcomes. The aim of this study is to examine factors associated with IV use of OMT medications and other intoxicating drugs 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 questionnaire. Binominal regression analysis with unadjusted and adjusted ORs was conducted to evaluate predictors for IV use.
  
  
  RESULTS
  Factors associated with the injection of a patient's own OMT medication were: being treated with buprenorphine-naloxone (BNX) (OR 2.60, p=0.005) with a low dose (<9.0mg/day; OR 5.70, p<0.001) and being treated in a health-care centre (OR 2.03, p=0.029). Factors associated with the injection of illicit OMT medications were: being treated with BNX (OR 5.25, p<0.001) with a low dose (<9.0mg/day; OR 2.89, p=0.017), lack of psychosocial support (OR 2.62, p<0.001) and concurrent use of psychotropic medications from illicit sources (OR 4.28, p<0.001). Associated factors for the injection of other intoxicating drugs were: concurrent use of illicit drugs (OR 1.72, p=0.015), psychotropic medications from illicit sources (OR 4.78, p<0.001) and from a doctor (OR 1.93, p=0.004).
  
  
  CONCLUSIONS
  More effort should be made to reduce concurrent injecting use during OMT. This may be done by addressing concurrent substance use orders more effectively, by ensuring that patients receive an optimal BNX dose and by providing more psychosocial support.
authors.affiliation: Clinicum, University of Helsinki and Helsinki University Hospital, P.O. 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.
authors.forename: Essiina
authors.initials: E
authors.lastname: Launonen
authors.affiliation: Department of Applied Health Research, University College London, Torrington Place, London WC1E 7HB, UK.
authors.forename: Isla
authors.initials: I
authors.lastname: Wallace
authors.affiliation: 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.
authors.forename: Elina
authors.initials: E
authors.lastname: Kotovirta
authors.affiliation: Clinicum, University of Helsinki and Helsinki University Hospital, P.O. 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.
authors.forename: Hannu
authors.initials: H
authors.lastname: Alho
authors.affiliation: Clinicum, University of Helsinki and Helsinki University Hospital, P.O. Box 63, FI-00014 Helsinki University, Finland; A-Clinic Foundation, Maistraatinportti 2, 00240 Helsinki, Finland.
authors.forename: Kaarlo
authors.initials: K
authors.lastname: Simojoki
mesh_terms: D061605:Administration, Intravenous / Q000523:psychology; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology*; D012044:Regression Analysis; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination
keywords: Buprenorphine; Intoxicating drugs; Intravenous use; Methadone; Misuse; Non-adherence; Opioid maintenance treatment; Psychosocial support