'Diversion’ of methadone or buprenorphine: 'harm’ versus 'helping’
1 Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, PO Box 4956, Oslo 0424, Norway
2 SERAF - Norwegian Centre for Addiction Research, University of Oslo, PO Box 1039, Oslo 0315, Norway
3 Institute of Health and Society, University of Oslo, Blindern, PO Box 1130, Oslo 0318, Norway
Harm Reduction Journal 2013, 10:24 doi:10.1186/1477-7517-10-24Published: 16 October 2013
'Non-compliant’ individuals in opioid maintenance treatment, OMT, are often met with tight control regimes to reduce the risk of 'diversion’, which may lead to harm or death among persons outside of OMT. This article explores reported practices of, and motivations for, diversion of methadone and buprenorphine, in a group of imprisoned individuals in OMT.
28 in-depths interviews were conducted among 12 OMT-enrolled, imprisoned individuals, most of whom were remand prisoners. All had experienced tight control regimes prior to imprisonment due to varying degrees of 'non-compliance’ and illicit drug use during treatment. Their acquired norm of sharing with others in a drug using community was maintained when entering OMT. Giving one’s prescription opioids to an individual in withdrawal was indeed seen as an act of helping, something that takes on particular significance for couples in which only one partner is included in OMT and the other is using illicit heroin. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. ’Diversion’, as this term is conventionally used, is not typically understood as practices of giving and helping, but may nevertheless be perceived as such by those who undertake them.
As we see it, the need to sustain oneself as a decent person in one’s own eyes and those of others through practices such as sharing and helping should be recognized. Treatment providers should consider including couples in which both individuals are motivated for starting OMT.