Department of Social Work, Malmö University, Malmö, Sweden.
Harm Reduct J. 2019 May 2;16(1):31. doi: 10.1186/s12954-019-0301-y.
Opioid substitution treatment (OST) with methadone or buprenorphine is the most effective means of treating opioid dependence. If these substances are used by people who are not undergoing OST, they can however carry serious risks. This article examines the lifetime prevalence, motives, and drug sources for such use, as well as geographical differences in these variables.
Structured interviews were conducted with 411 patients from 11 OST clinics in five Swedish cities. The researchers carried out 280 interviews on-site, while 131 interviews were conducted by specially trained patients through privileged access interviewing. Data were analyzed by frequency and average calculations, cross-tabulations, and χ tests.
The lifetime prevalence of non-prescribed use was 87.8% for methadone, 80.5% for buprenorphine, and 50.6% for buprenorphine/naloxone. Pseudo-therapeutic motives-avoiding withdrawal symptoms, staying clean from heroin, detoxification, or taking care of one's own OST-were commonly cited as driving the use, while using the drugs for euphoric purposes was a less common motive. Most respondents had bought or received the substances from patients in OST, but dealers were also a significant source of non-prescribed methadone and buprenorphine. Geographical differences of use, motives, and sources suggest that prescription practices in OST have a great impact on which substances are used outside of the treatment.
Experiences of non-prescribed use of methadone and buprenorphine are extremely common among those in OST in southern Sweden. As the use is typically driven by pseudo-therapeutic motives, increased access to OST might decrease the illicit demand for these substances. Buprenorphine/naloxone has a lower abuse potential than buprenorphine and should therefore be prioritized as the prescribed drug. Supervised dosage and other control measures are important provisions in the prevention of drug diversion and non-prescribed use among people not undergoing OST.
美沙酮或丁丙诺啡替代治疗（OST）是治疗阿片类药物依赖最有效的方法。如果这些物质被未接受 OST 的人使用，他们可能会面临严重的风险。本文研究了这些物质的使用的终身流行率、动机和药物来源，以及这些变量的地理差异。
对来自瑞典五个城市的 11 个 OST 诊所的 411 名患者进行了结构化访谈。研究人员在现场进行了 280 次访谈，而通过特权访问访谈，有 131 次访谈是由经过专门培训的患者进行的。数据通过频率和平均值计算、交叉表和 χ 检验进行分析。
非处方使用的终身流行率为美沙酮 87.8%、丁丙诺啡 80.5%、丁丙诺啡/纳洛酮 50.6%。避免戒断症状、远离海洛因、戒毒或照顾自己的 OST 等假性治疗动机被普遍认为是使用这些药物的驱动因素，而使用药物产生欣快感则是较少见的动机。大多数受访者从 OST 中的患者那里购买或收到这些药物，但经销商也是非处方美沙酮和丁丙诺啡的重要来源。使用、动机和来源的地理差异表明，OST 中的处方实践对治疗以外使用哪些药物有很大影响。
在瑞典南部接受 OST 的人中，非处方使用美沙酮和丁丙诺啡的经验非常普遍。由于这种使用通常是由假性治疗动机驱动的，因此增加 OST 的可及性可能会减少这些物质的非法需求。丁丙诺啡/纳洛酮的滥用潜力低于丁丙诺啡，因此应优先作为处方药物。剂量监督和其他控制措施是防止非接受 OST 的人药物转移和非处方使用的重要规定。
