'Diversion’ of methadone or buprenorphine: 'harm’ versus 'helping’

Background '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. Findings 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. Conclusions 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

The anabolic androgenic steroid treatment gap: a national study of substance use disorder treatment

Background Anabolic-androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use amongst people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD-treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results Lifetime AAS use was reported by 156 (28.3%) SUD-patients, thereof 35.6 % of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS using men. AAS users reported more severe substance use than non-AAS users. More than half (58%)of all patients had not been asked about AAS use, and 42.4% of those who were asked, experienced that treatment providers lacked expertise about AAS. Conclusion Lifetime AAS use in this sample of SUD patients is common practice and comprise an underrecognized problem in SUD treatment. Given the deleterious implications to the individual and society that concomitant use of AAS may cause, it would be essential to raise the awareness about AAS use amongst SUD patients, and the level of competence among health professionals

CHARGING AND DETECTION OF MESOSPHERIC DUST WITH INSTRUMENT SPID ON G-CHASER ROCKET

The Smoke Particle Impact Detector (SPID) was flown on the G-Chaser student rocket that was launched from Andøya on 13 January 2019. SPID is a Faraday cup instrument with applied bias voltages to deflect the ambient plasma and a target area inside the probe designed to measure the dust particles by charge detection. The charging process of the dust particles in the detector is important for interpretation of the measurements and the influence of the charging models is discussed. Preliminary analysis of the SPID observations shows that ambient plasma and sunlight had an influence on the signals; further analysis is needed to retrieve information on impacting dust from the data

Violence and diversion of prescribed opioids among individuals in opioid maintenance treatment. A complementary methods study of violent crime convictions in a national cohort and qualitative interviews among prisoners

Background: Opioid dependence is linked to crime, morbidity and mortality, directly through drug overdoses and indirectly via drug-related mortality, accidents, suicides and violence. Violence in general is a major health concern worldwide. Opioid maintenance treatment, OMT, is found to reduce mortality, morbidity and criminal behaviour, but less is known about the effect of OMT on violent crime. A possible negative consequence of OMT is diversion of methadone and buprenorphine and rising overdose deaths related to these medications among individuals not enrolled in OMT. The aim of this thesis is to study violent crimes prior to, during and after OMT in a national cohort and to generate new knowledge about OMT-enrolled individuals’ experiences and understandings of being both violent and non-violent offenders, the role of substances in such crimes as well as their understandings and motivations related to diversion of prescribed opioids. Materials and methods: Two complementary data collection methods have been used. Violent convictions were investigated by use of cross-registry methods for a complete longitudinal national OMTcohort of 3221 individuals with an observation period of 9 years and a qualitative study among 12 imprisoned, OMT-enrolled individuals. 28 semi-structured interviews were thematically analyzed with a reflexive and interactive approach. Findings: Violent crime rates were significantly reduced during OMT compared with before treatment. The rate of convictions for violent crime during OMT was halved among those who remained in treatment. The reduction was less pronounced for those who left treatment: for this group, the rate of violent convictions after OMT was higher than before treatment. The risk of convictions for violent and non-violent crime during OMT was highest for those with violent convictions prior to treatment. In the qualitative part of the study, it was found that substances and, in particular, high-dose benzodiazepines were deliberately used to induce temporary ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use prior to OMT. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. They were found to exhibit a considerable amount of self-control, selfregulation and/or self-initiation of external control related to intake of methadone and buprenorphine in various settings. Their acquired norm of sharing with others in a drug using community was carried along when entering OMT. Several had developed strategies to avoid selling or giving of methadone or buprenorphine to others. Giving one’s opioid prescriptions to an individual in withdrawal, was seen as an act of helping. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. Conclusions: Opioid dependent individuals with violent convictions should have access to OMT. Treatment providers should identify individuals with histories of violent behavior. The situation that precede and motivate violent behavior and the potential role of substances prior to and after such crimes should be explored with the patient in question. What appears as a severe antisocial personality disorder may be partly explained by substance use. Treatment providers should explore the living conditions and social lives of individuals applying for and enrolled in OMT. To following OMT guidelines may entail breaking a personal and drug culture norm of sharing and helping by means of providing OMT medications to those in need. Opioid-dependent couples should be encouraged to apply for and enroll in OMT at the same time, if both are motivated for starting treatment. Some individuals might know what particular configurations of internal and external control they need in order to achieve their own treatment goals in OMT. An individual’s experience and ability to execute self-control and self-regulation with regard to drug taking may be seen as a resource throughout the course of treatment

Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use

Background Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. Methods Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. Results The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients’ own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. Conclusions The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients’ contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client’s quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment

The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment

Background Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions. Methods Twenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach. Findings Prior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. Conclusions Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use

Alienation and Lack of Trust: Barriers to Seeking Substance Use Disorder Treatment Among Men Who Struggle to Cease Anabolic-androgenic Steroid Use

Anabolic-androgenic steroid (AAS) use became illegal when the Norwegian Drug Act was amended in 2013, and AAS and other image- and performance-enhancing drugs were included in the politics and treatment of substance use. Few individuals with AAS-related health problems seek substance use disorder (SUD) treatment. This article aims to explore understandings of AAS dependence, barriers to treatment-seeking, and experiences of entering SUD treatment among a sample of men with AAS-related health problems struggling to cease AAS use. Seeking treatment for AAS-related health problems within SUD treatment services was described as alienating. First, because the participants experienced their struggle to quit using AAS to be different from being dependent upon psychoactive substances. They linked their struggles to symptoms of hormonal disturbance, need for a certain body size, and/or the sense of wellbeing provided by AAS and which enable them to function socially. Second, they experienced alienation because of their healthy identities, bodies and lifestyles, as opposed to how they viewed individuals with severe SUDs and emaciated bodies. A major barrier to treatment-seeking was participants’ lack of trust that SUD treatment providers had the knowledge and the means to provide treatment of their AAS-related health problems and struggle to quit AAS use. Experienced barriers towards seeking SUD treatment should be taken into account when planning, organizing and implementing health services for individuals with AAS-related health problems