Medication diversion among HIV-positive substance abusers in Miami

Background: Prescription drug “diversion” -- the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace – has received increased attention over the past few years. This paper focuses on a previously unstudied topic -- the diversion of antiretroviral medications (ARV) for HIV – and examines the patterns and predictors of ARV diversion among drug-involved HIV-positive individuals in Miami.

Methods: Using targeted sampling strategies, this study is enrolling indigent HIV positive substance abusers in Miami. To date, we have conducted structured face to face interviews with 222 individuals using standardized data collection instruments. Bivariate logistic regression models were developed to examine risk and protective factors for ARV diversion.

Results: The sample has a median age of 46 and 82.4% meet criteria for substance abuse/dependence. 30.6% report diverting their ARV medications in the 90 days prior to interview. Significant risk factors for ARV diversion include: homelessness, severe depression, severe traumatic stress, prescription opioid misuse and sedative misuse. Protective factors include: family support, higher HIV treatment knowledge, and more favorable attitudes toward ARVs.

Conclusions: The health implications of ARV diversion among substance abusers are substantial. Many individuals are not consistently adhering to their medication regimens, and therefore fail to achieve the full benefits of ARV treatment. In addition, the potential for transmission of medication-resistant strains of HIV is increased. At this early stage, we have observed important differences in the street market for ARV medications, in contrast to the illicit market for abusable prescription medications. These findings will be discussed.