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Heroin Addiction and Related Clinical Problems: 2017, 19, N1 (pages: 27 - 40)

Understanding Diversion of Prescribed Opioid Agonist Medications in Birmingham, Uk—Prevalence and Predictors of Diversion

Ratcliffe K., Chopra B., and Day E.

Summary: Background: Opioid agonist treatment (OAT) is an evidence-based intervention but concerns persist regarding diversion. Aim: This study assessed the prevalence of and motivating factors behind OAT diversion and acquisition of illicit OAT self-reported by persons treated within OAT programmes or accessing needle and syringe programmes (NSPs) in Birmingham, UK. Methods: 511 people in OAT programmes and 105 NSP users completed anonymous questionnaires consisting of 25 open and closed questions. Logistic regression analysis was used to explore associations between OAT diversion and acquisition of illicit OAT. Results: 32.5% (95% CI 28.4-36.6%) of people in OAT programmes self-reported diversion at some point. 12.1% (n=62) had diverted at least once a week. 25.2% (n=129) reported current diversion, with giving it away (n=64, 49.6%) more common than selling (n=21, 16.3%); 44 (34.1%) reported both reasons. In NSPs, most was purchased (67/74, 90.5%). In OAT programmes, the likelihood of diversion was higher in those who continued to use illicit drugs (OR=3.65, 95% CI 1.76–7.56, p=0.0005) and in people not taking the full dose of OAT. Rates of diversion appeared to be similar among all subgroups of illicit drug users. No difference in the risk of diversion of methadone and buprenorphine was found. OAT acquisition was common in OAT programmes (63.6%, 95% CI 59.4–67.8) and highly associated with continued illicit drug use and long-duration in treatment, and common in NSPs (70.5%, 95% CI 61.8–79.2%). Conclusions: Diversion and acquisition rates of OAT were high but consistent with previous European studies. The predictors identified offer important clues to reduce these activities, and point to the importance of optimised OAT with awareness of diversion potential, side effect profile, and effective supervision.