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Published: 15 November 2011

Opioids other than heroin

Increasing illicit use of opioids other than heroin has been reported in Australia, Canada, Europe and the United States (SAMHSA, 2009). Most of these substances are used in medical practice, as pain relievers (morphine, fentanyl, codeine, oxycodone, hydrocodone) or as substitution drugs in the treatment of heroin dependence (methadone, buprenorphine). As with heroin, the non- medical use of these substances can lead to a range of adverse health effects, including dependence, overdose and harm associated with injection.

In Europe, about 5 % (around 20 000 patients) of all treatment entrants declare opioids other than heroin as their primary drug. This is particularly the case in Estonia, where 75 % report fentanyl as their primary drug, and in Finland, where buprenorphine is reported as the primary drug of 58 % of treatment entrants. Other countries with significant proportions of clients reporting methadone, morphine and other opioids as primary drug include Denmark, France, Austria, Slovakia and Sweden, where non-heroin opioid users account for between 7 % and 17 % of all drug clients (1). The Czech Republic also reports that buprenorphine users accounted for more than 40 % of all problem opioid users between 2006 and 2009.

Levels of illicit use of opioids may be linked with a mixture of factors including the drug market and prescription practices. For example, a decrease in heroin availability and an increase in its price may lead to the use of other opioids, as was observed in Estonia with fentanyl (Talu et al., 2010) and in Finland with buprenorphine (Aalto et al., 2007). Inappropriate prescription practices can also lead to illicit use of opioid drugs. The expansion of substitution treatment accompanied by a lack of supervision can create an illicit market, while limited availability of this treatment and the prescription of substitution doses that are too low can lead users to take other substances as a self-medication (Bell, 2010; Roche et al., 2011; Romelsjo et al., 2010).

(1) See Table TDI-113 in the 2011 statistical bulletin.

Aalto, M., Halme, J., Visapaa, J.-P. and Salaspuro, M. (2007), ‘Buprenorphine misuse in Finland’, Substance Use & Misuse 42, pp. 1027–8.

Bell, J. (2010), ‘The global diversion of pharmaceutical drugs: opiate treatment and the diversion of pharmaceutical opiates: a clinician’s perspective’, Addiction 105, pp. 1531–7.

Roche, A., McCabe, S. and Smyth, B. (2011), ‘Illicit methadone use and abuse in young people accessing treatment in opiate dependence’, European Addiction Research 14, pp. 219–25.

Romelsjo, A., Engdahl, B., Stenbacka, M., Fugelstad, A., Davstad, I. et al. (2010), ‘Were the changes to Sweden’s maintenance treatment policy 2000–06 related to changes in opiate-related mortality and morbidity?’, Addiction 105, pp. 1625–32.

SAMHSA (2009), Trends in nonmedical use of prescription pain relievers: 2002 to 2007, Substance Abuse and Mental Health Services Administration, Rockville, MD.

Talu, A., Rajaleid, K., Abel-Ollo, K., Ruutel, M., Rahu, M. et al. (2010), ‘HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention’, Journal of Drug Policy 21(1), pp. 56–63.

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