Background
Non-prescribed
use of opioid substitution medication (NPU) appears to represent a relevant
source of opioids among European drug users. Little is known about the
prevalence of NPU in Germany and possible differences between subgroups of
opioid users. The present study examines NPU and other drug use patterns among
drug consumption room (DCR) clients, opioid substituted DCR clients, and
patients recruited in opioid substitution treatment (OST) practices.
Methods
Cross-sectional
data was collected in 2011 from 842 opioid users in 10 DCRs and 12 OST
practices across 11 German cities. Structured interviews comprised indicators
for socio-demographics, health status, drug use, motives for NPU, and the
availability and price of illicit substitution medication. Group differences
were examined with one-way ANOVAs, chi-square tests, or t-tests,
and factors for NPU were included in a multivariate model. Over-time
comparisons were performed with similar data collected in 2008.
Results
Lifetime,
30-day and 24-h NPU prevalence for the total sample was 76.5%, 21.9%, and 9.3%,
respectively, with methadone being the most frequently used substance. NPU,
poly-drug use and injection drug use were more common among DCR clients,
especially among DCR clients not in OST. The three groups featured distinct
socio-demographic characteristics, with substituted patients being more
socially integrated, while few differences in health parameters emerged.
Motives for NPU were mostly related to potential shortcomings of OST, such as
insufficient dosages, difficulties with transportation, and lack of access. NPU
prevalence was found to be higher than in 2008, while injection rate of
substitution medication was similarly low. Main factors associated with NPU were
not being in OST, past 24-h use of other drugs, and younger age.
Conclusion
Although
diverted methadone or buprenorphine are rarely used as main drugs, NPU is
prevalent among opioid users, particularly among DCR clients not in OST. OST
reduces NPU if opioid users’ needs are met.
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By:
Affiliations
Centre for Interdisciplinary Addiction Research, University
Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
Correspondence
Corresponding author. Tel.: +49 040 7410 57906.
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