• According to the Substance Abuse and Mental Health Services Administration (2012), 669,000 people used heroin in the previous year in the United States. As well, the number of heroin users increased every year for five years in a row.
• Although methadone is an effective treatment for patients with opioid use disorder and chronic pain, fatalities have continued to rise due to illicit methadone use.
• The authors aimed to look at the factors associated with methadone injection in an urban Canadian setting where access to methadone prescribed through primary care physicians is common.
The authors used two prospective cohorts of individuals who use drugs in Vancouver (Vancouver Injection Drug Users Study (VIDUS), and AIDS Care Cohort).
• Approximately 7% of participants injected methadone over the study period. The authors found this behaviour to be associated with socioeconomic vulnerability and other addictions.
• Methadone injection was not associated with enrolment in a methadone program. Interestingly, the findings of this study contrast with other studies, which propose that enrolment in a methadone maintenance program is associated with injection of methadone. Due to this, the authors suggest that these individuals may represent a sub-population of PWID “for whom evidence-based addiction treatment services remain out of reach.”
• The rates of diversion (transfer of legally prescribed drugs from the patient to another person for illicit use) show a need to implement tools that enhance the flexibility of program rules for patients at low risk of diversion. , while at the same time ensuring that patients at risk of selling their medication ingest their medication at the time it is provided.
• However, the authors also note that PWID may be purchasing and using street methadone as a means to reduce their heroin consumption and self-treat opioid withdrawal symptoms.
The injection of methadone is associated with several other high-risk behaviors. Due to this, access to methadone programs should be optimized while also making efforts to limit diversion of methadone to the street.
Tucker, D., Milloy, M.J., Hayashi, K., Nguyen, P., Kerr, T., and Wood, K. (2015). Factors Associated with Illicit Methadone Injecting in a Canadian Setting. The American Journal on Addictions. 24:532-537.