Why Switch? - Motivations for Self-Substitution of Illegal Drugs

Abstract

Background

Self-substitution is the conscious switch from one drug to another for reasons such as price, availability, desired effect, or perceived benefit of the substitute drug. Purpose/Objectives: This study aimed to describe drug use patterns and motivations associated with substitution. We examined correlates of lifetime substitution among individuals with substance use disorder. Methods: A cross-sectional study of 771 treatment-enrolled individuals. We used self-report for determining the lifetime prevalence, correlates, and motivations for substitution. Results: Of the 771 respondents, 570 (73.9%) reported ever substituting their preferred substance. The main incentives for substitution were availability (23.7%) and curiosity (20.2%). Among heroin or cannabis preferers, improved effects or less adverse effects of the substitute drug, self-medication, and managing withdrawal symptoms were significant substitution incentives. Increased odds for substitution were observed for past 12 months use of cannabis (OR = 1.51, CI = 1.06-4.52), prescription opioids (OR = 2.86, CI = 1.81-4.52), novel psychoactive substances (OR = 2.68, CI = 1.64-4.36), and repeated admission (OR = 1.50, CI = 1.05-2.14). Older age at onset-of-use was negatively associated with substitution (OR = 0.95, CI = 0.93-0.98). Conclusions: Self-substitution of one substance for another is a highly prevalent behavior among treatment-enrolled patients with substance use disorder. Clinicians caring for substance use disorder patients should be aware of substitution patterns involving the use of highly potent substances, which constitutes a risk to patients. Results underscore the benefit of substitution patterns analyses, as they reveal important information on the characteristics of persons who use drugs and their motivations.

Keywords:

• Substitution
• cocaine
• heroin
• cannabis
• motivation
• drugs
• synthetic cannabinoids

Acknowledgements

The authors of the study wish to express their gratitude for the valuable administrative assistance provided by the staff of the Be’er-Sheva Mental Health Center, Sha’ar Menashe Mental Health Center, Renaissance-Victoria, and Tamra in-patient centers.

Disclosure statement

The authors report no conflict of interest. The study is part of the corresponding author’s Ph.D. dissertation.

Additional information

Funding

This study was supported by the Israel Authority for Prevention of Violence, Alcohol, and Drug Abuse under grant number 0394937.