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, but 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, four used methadone and buprenorphine, and one 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 two people had taken the pill form.
• All but one 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 by James Harrison, MHS, CADC
This study provides evidence that opioid-dependent individuals will attempt to treat themselves using diverted methadone or buprenorphine. The modest doses of diverted agents suggest a harm-reduction method developed on the street to prevent withdrawal for those who have not entered treatment. Professional treatment for opioid dependence is still the safest option. As such, effective street outreach targeting untreated populations seeking OAT is clearly warranted.