Non-prescribed use of substitution medication among German drug users - Prevalence, motives and availability (2013)

Although opioid substitution treatment (OST) is regarded as the most effective treatment option for opiate dependence (World Health Organization, 2008) leading to reductions in illicit drug use, injection use and criminal activity (Mattick et al., 2009 and Soyka et al., 2012), the non-prescribed use of substitution medication (NPU) may raise concerns. European estimates on the extent of NPU among drug users show considerable variation between countries. Rates for current NPU (i.e. within the previous 24 h) range from 5.6% in Portugal (Vale Andrade et al., 2007) to 73% in Finland (Alho et al., 2007).
Motives for NPU also vary, and comprise limited availability of either heroin or OST, a "lack of responsibility" among drug users as well as financial aspects, i.e. the lower prices of substitution medication compared to heroin (EMCDDA, 2005 and Scherbaum et al., 2005).
In Germany, mainly office-based general practitioners, but also clinics and pharmacies dispense OST medication, and the legal framework allows take-home prescription for a dosage up to seven days (Michels, Stöver, & Gerlach, 2007). Concerning the extent of NPU, three German studies are currently available. One survey with 142 patients in a detoxification facility found a lifetime prevalence of 53.5% (Scherbaum et al., 2005). One study using long-term monitoring data from drug counselling centres reported an increasing portion of methadone/buprenorphine among currently misused medication from 6.9% in 2003 to 20.7% in 2006 (Rösner & Küfner, 2007). In a sample of 175 heroin users recruited in low-threshold services, lifetime prevalence of injection of substitution medication was 57.1%, and 26.9% in past 30 days (Leicht, 2005).
This study aimed to explore the extent of NPU among a larger sample of active drug users, the availability of substitution medication on the black market, and to reveal motives for NPU. [Introduction]