Diverted Methadone and Buprenorphine Primarily Used to Prevent Withdrawal or to Stop Using Heroin

Opioid agonist treatment (OAT) with methadone or buprenorphine is effective for reducing illicit drug use among opioid-dependent patients. However, the diversion of these agents may be harmful. As part of a larger longitudinal study conducted in Baltimore, MD, between 2004 and 2007, a subsample of the original 515 opioid-dependent subjects, most of whom were seeking methadone treatment, were recruited to undergo in-depth interviews regarding their use of diverted methadone or buprenorphine.

• Twenty-two people (24% of the subjects interviewed) reported using diverted methadone or buprenorphine. Of these, 17 used methadone only, 4 used methadone and buprenorphine, and 1 used buprenorphine only.

• Those who used diverted methadone were more likely to have been enrolled in OAT in the past and were less likely to have used heroin or cocaine in the past month.

• Most of the diverted methadone used was in liquid form. Only 2 people had taken the pill form.

• All but 1 subject used the diverted medication to prevent withdrawal symptoms or to stop using heroin, and all generally took modest doses (about 30–40 mg per day of methadone and 4 mg per day of buprenorphine).

Comments:

Although this was a small sample of an opioid-dependent population in 1 locale, it is reassuring that diverted methadone and buprenorphine was primarily taken to reduce heroin use, and that modest doses were used. However, this study does not allay concern about the potential dangers of these drugs among the less experienced people who use them.

Darius A. Rastegar, MD

Reference:

Mitchell SG, Kelly SM, Brown BS, et al. Uses of diverted methadone and buprenorphine by opioid-addicted individuals in Baltimore, Maryland. Am J Addict. 2009;18(5):346–355.