Beyond harm-producing versus harm-reducing: A qualitative meta-synthesis of people who use drugs' perspectives of and experiences with the extramedical use and diversion of buprenorphine

Sud, Abhimanyu; Salamanca-Buentello, Fabio; Buchman, Daniel Z.; Sabioni, Pamela; Majid, Umair

doi:10.1016/j.jsat.2021.108651

Cited by 12 publications

(17 citation statements)

References 67 publications

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“…Although existing literature has synthesized and described the extent and motivations for extramedical buprenorphine use [33,45,46], our review is the first to systematically document patterns of injection and adverse events among people who inject buprenorphine regularly. The studies summarized here could be characterized as coming from countries where either diverted oral buprenorphine is easily accessible (i.e.…”

Section: Discussionmentioning

confidence: 99%

Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Bozinoff

Tardelli²,

Rubin-Kahana³

et al. 2022

Harm Reduct J

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Background and Aims Given the ongoing opioid crisis, novel interventions to treat severe opioid use disorder (OUD) are urgently needed. Injectable opioid agonist therapy (iOAT) with diacetylmorphine or hydromorphone is effective for the treatment of severe, treatment-refractory OUD, however barriers to implementation persist. Intravenous buprenorphine for the treatment of OUD (BUP iOAT) has several possible advantages over traditional iOAT, including a safety profile that might enable take-home dosing. We aimed to characterize injecting practices among real-world populations of persons who regularly inject buprenorphine, as well as associated adverse events reported in order to inform a possible future BUP iOAT intervention. Methods We conducted a systematic review. We searched MEDLINE, EMBASE, and PsycINFO from inception through July 2020 and used backwards citation screening to search for publications reporting on dose, frequency among persons who regularly inject the drug, or adverse events associated with intravenous use of buprenorphine. The review was limited to English language publications and there was no limitation on study type. Study quality and risk of bias was assessed using the Mixed Methods Appraisal Tool. Narrative synthesis was used in reporting the results. Results Eighty-eight studies were included in our review. Regular injection of buprenorphine was identified across diverse settings world-wide. Daily dose of oral buprenorphine injected was < 1–12 mg. Frequency of injection was 0–10 times daily. Adverse events could be characterized as known side effects of opioids/buprenorphine or injection-related complications. Most studies were deemed to be of low quality. Conclusions Extramedical, intravenous use of buprenorphine, continues to be documented. BUP iOAT may be feasible and results may inform the development of a study to test the efficacy and safety of such an intervention. Future work should also examine acceptability among people with severe OUD in North America. Our review was limited by the quality of included studies.

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Section: Discussionmentioning

confidence: 99%

Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Bozinoff

Tardelli²,

Rubin-Kahana³

et al. 2022

Harm Reduct J

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“…Unlike PWUO, who have either not provided or not been asked about solutions to extramedical use, 22 we identified several levels of responses and solutions offered by providers. Although most of the driving factors for extramedical use described above were at the systems level, most of the proposed solutions by providers were at the individual level in the form of prescribing changes and monitoring 32,33,35,37,39,44,46 .…”

Section: Resultsmentioning

confidence: 99%

“…Providers in this synthesis also identified that they changed their prescribing practices, such as reducing prescribed doses, to minimize the risk of extramedical use. Such practices contribute to the barriers that PWUO already face in accessing treatment, and may perversely drive further extramedical use 22 …”

Section: Discussionmentioning

confidence: 99%

“…Such practices contribute to the barriers that PWUO already face in accessing treatment, and may perversely drive further extramedical use. 22 This suggests a key disconnect in provider views: they saw that macro, health care system-level challenges primarily drove extramedical use, but their recommended solutions were primarily at the micro, individual patient level. The macro-micro disconnect in health care governance may help to explain this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

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Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

Gamage

Tejpar

Majid

et al. 2022

Journal of Addiction Medicine

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Objectives: Opioid agonist therapy using buprenorphine is one of the most effective treatments for opioid use disorder. However, concerns regarding its extramedical use and diversion, such as adverse patient outcomes and damage to the legitimacy of addictions practice, are persistent. The aim of this review is to synthesize the perspectives and experiences of health care providers around the extramedical use of buprenorphine. Methods: A qualitative meta-synthesis was conducted based on a systematic search of 8 databases. All primary qualitative and mixedmethods studies relating to the views of health care providers on the extramedical use of buprenorphine were included. A qualitative analysis informed by the constant comparative method was conducted, using NVivo for data management. Results: Sixteen studies were included in this review. Findings were organizedunder 2 key themes: (1) Harm-producing versus harmreducing effects of extramedical buprenorphine use and (2) driving forces of and responses to extramedical buprenorphine use. Conclusions:The studies included in our review identified a disconnect-health care providers noted that macro, health care system-level challenges drove extramedical use whereas the recommended solutions for prevention and management were primarily aimed at the micro, individual level. This study emphasizes the critical role that health care providers can play, in partnership with patients, in informing appropriate policies and health care system design to optimize the care for people with opioid use disorder.

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“…In this study, the process of analysis began at the same time as data collection, as well as, constant comparison 25 , 26 . The primary researcher programmed three-level coding of the proofread records using the qualitative software NVivo 11.0 ( https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home ) to identify specific topics 27 . (1) Open coding.…”

Section: Methodsmentioning

confidence: 99%

Factors influencing compliance in RRD patients with the face-down position via grounded theory approach

Shao

et al. 2022

Sci Rep

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Patients with rhegmatogenous retinal detachment (RRD) require face-down positioning (FDP) for 3–6 months or longer after pars plana vitrectomy (PPV) combined with silicone oil (SO) tamponade. This paper aimed to identify the factors that influenced FDP compliance. This study adopted semi-structured interviews with patients who require FDP after SO tamponade. Constructivist grounded theory was utilized in this study. The qualitative data was analyzed and coded via NVivo 11.0 through open coding, axial coding and selective coding. Twenty-four RRD patients were involved. The interviews yielded five main themes that defined home FDP compliance were identified: posture discomfort, doctor-patient communication, psychological factors, occupational character, and family factors. A theoretical model of the influencing factors of postural compliance of FDP was constructed based on the interview analysis. A variety of factors can affect FDP conformity. We can increase compliance of RRD patients by enhancing comfort, encouraging doctor-patient communication, providing comprehensive care, promoting community-based intervention, and strengthening family education.

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Beyond harm-producing versus harm-reducing: A qualitative meta-synthesis of people who use drugs' perspectives of and experiences with the extramedical use and diversion of buprenorphine

Cited by 12 publications

References 67 publications

Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review

Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

Factors influencing compliance in RRD patients with the face-down position via grounded theory approach

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