PMID- 32742781
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220416
IS  - 2167-8359 (Print)
IS  - 2167-8359 (Electronic)
IS  - 2167-8359 (Linking)
VI  - 8
DP  - 2020
TI  - The switch from one substance-of-abuse to another: illicit drug substitution 
      behaviors in a sample of high-risk drug users.
PG  - e9461
LID - 10.7717/peerj.9461 [doi]
LID - e9461
AB  - BACKGROUND: Substitution can be defined as the consciously motivated choice to 
      use one drug, either licit or illicit, instead of another, due to perceptions of 
      cost, availability, safety, legality, substance characteristics, and substance 
      attributions. Substitution represents a potential risk to drug users, mainly when 
      substitutes are of higher potency and toxicity. This study offers a basic 
      conceptualization of illicit substitution behavior and describes substitution 
      patterns among users of two highly prevalent drugs of abuse-heroin and cannabis. 
      METHODS: Here, 592 high-risk drug users undergoing pharmacological and 
      psycho-social treatment were interviewed. Patients were asked questions about 
      current drug use, lifetime substitution, and substitution patterns. Descriptive 
      statistics, chi-square tests of independence, and multinomial logistic 
      regressions were used to identify and test correlates of substitution patterns 
      for heroin and cannabis. RESULTS: Of the 592 drug users interviewed, 448 subjects 
      (75.7%) reported having substituted their preferred drug for another illicit 
      substance. Interviews yielded a total of 275 substitution events reported by 
      users of cannabis, and 351 substitution events reported by users of heroin. The 
      most frequently reported substitution substances for responders who preferred 
      heroin were illicit non-prescribed "street" methadone (35.9%), followed by oral 
      and transdermal prescription opioids (17.7%). For responders who preferred 
      cannabis, substitution for synthetic cannabinoid receptor agonists (33.5%) 
      followed by alcohol (16.0%) were the most commonly reported. Age at onset-of-use 
      (p < 0.005), population group (p = 0.008), and attending treatment for the first 
      time (p = 0.026) were significantly associated with reported lifetime 
      substitution. Past-year use of stimulants, heroin, hallucinogens, 
      methylenedioxymethamphetamine (MDMA), and novel psychoactive substances were-at 
      the 95% confidence level-also significantly associated with reported lifetime 
      substitution. In multivariate analysis, the odds for methadone substitution among 
      heroin users were significantly affected by age at onset-of-use, type of 
      treatment center, and education. Odds for substitution for synthetic cannabinoid 
      receptor agonists among cannabis users were significantly affected by age, 
      population group, type of treatment center, and education. CONCLUSION: 
      Self-substitution behavior should be considered by clinicians and policymakers as 
      a common practice among most drugusers. Substitution for street methadone 
      provides evidence for the ongoing diversion of this substance from Opioid 
      Maintenance Treatment Centers, while the prominence of substitution of synthetic 
      cannabinoids among dual-diagnosis patients should be regarded as an ongoing risk 
      to patients that needs to be addressed by clinicians. Analysis of additional 
      substitution patterns should provide further valuable insights into the behavior 
      of drugusers.
CI  - (c)2020 Shapira et al.
FAU - Shapira, Barak
AU  - Shapira B
AD  - Braun School of Public Health and Community Medicine, Hebrew University of 
      Jerusalem, Jerusalem, Israel.
AD  - Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, 
      Israel.
FAU - Rosca, Paola
AU  - Rosca P
AD  - Department for the Treatment of Substance Abuse, Israel Ministry of Health, 
      Jerusalem, Israel.
FAU - Berkovitz, Ronny
AU  - Berkovitz R
AD  - Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, 
      Israel.
FAU - Gorjaltsan, Igor
AU  - Gorjaltsan I
AD  - Beer-Sheva Mental Health Center, Beer-Sheva, Israel.
FAU - Neumark, Yehuda
AU  - Neumark Y
AD  - Braun School of Public Health and Community Medicine, Hebrew University of 
      Jerusalem, Jerusalem, Israel.
LA  - eng
PT  - Journal Article
DEP - 20200717
PL  - United States
TA  - PeerJ
JT  - PeerJ
JID - 101603425
PMC - PMC7370931
OTO - NOTNLM
OT  - Cannabis
OT  - Heroin
OT  - Israel
OT  - Methadone
OT  - Substitution
OT  - Synthetic cannabinoids
COIS- The authors declare there are no competing interests.
EDAT- 2020/08/04 06:00
MHDA- 2020/08/04 06:01
PMCR- 2020/07/17
CRDT- 2020/08/04 06:00
PHST- 2020/01/29 00:00 [received]
PHST- 2020/06/10 00:00 [accepted]
PHST- 2020/08/04 06:00 [entrez]
PHST- 2020/08/04 06:00 [pubmed]
PHST- 2020/08/04 06:01 [medline]
PHST- 2020/07/17 00:00 [pmc-release]
AID - 9461 [pii]
AID - 10.7717/peerj.9461 [doi]
PST - epublish
SO  - PeerJ. 2020 Jul 17;8:e9461. doi: 10.7717/peerj.9461. eCollection 2020.