The nature of methadone diversion in England: a Merseyside case study

Questionnaires were completed (in interview format) with 886 past year users of methadone recruited both in and out of prescribing agencies. Topic areas covered included current prescribing, obtaining and providing methadone, reasons for using illicit methadone and other drug use.Large proportions of participants had obtained illicit methadone for use in the past year with smaller proportions doing so in the past month. Proportions of participants buying and being given methadone were similar. Exchange of methadone primarily took place between friends and associates, with 'dealers' rarely involved. Gender, age, whether participant's methadone consumption was supervised and whether the aims of their treatment had been explained to them fully, influenced the extent to which participants were involved in diverting or using diverted methadone.Methadone diversion is widespread although drug users generally do not make use of illicit methadone regularly (every month). The degree of altruism involved in the exchange of methadone does not negate the potential role of this action in overdose or the possibility of criminal justice action against individuals. Treatment agencies need to emphasise these risks whilst ensuring that treatment aims are effectively shared with clients to ensure adherence to treatment.Whilst the effectiveness of the various models of methadone treatment has been established through international research [1-5], concerns have been expressed about the potential 'leakage' of methadone onto the 'black market' and the increased risk of harm that this entails [6-8]. The diversion of methadone has been implicated as a key contributing factor in fatal and non-fatal methadone poisonings [9-12]. The risk of street selling of methadone and its association with overdose have also been recognised by drug users being prescribed substitute medication [13].Investigative studies in developed countries have examined the prevalence and nature of methadone diversion and