Consumer attitudes about opioid addiction treatment: A focus group study in New York City

Abstract

Objective To develop effective programs for people who are opioid-dependent and to impact the opioid epidemic in New York City, it is crucial that we monitor attitudes about opioid addiction treatments among opioid users who have experienced barriers to engagement and retention in addiction treatment. Design We conducted a qualitative study using focus groups. Methods We conducted six focus groups in three needle exchanges in New York City, which were audio recorded, transcribed, and systematically coded. We report on the main themes related to the study objectives. Participants Participants of each needle exchange who were opioid-dependent and had some knowledge of both methadone and buprenorphine were eligible. Results There were four main findings. Participants felt: (1) buprenorphine is an appropriate option only for those heroin users who are motivated to stop using; (2) they have less control over their addiction treatment with methadone than they would have with buprenorphine; (3) buprenorphine treatment is not accessible to many New York City residents who would benefit from this treatment; and (4) lack of access to buprenorphine treatment is the cause of treatment-related diversion. Conclusions Both methadone maintenance and buprenorphine treatment opportunities are necessary to address the diverse treatment needs of opioid-dependent people in New York City. However, the current medical model of buprenorphine treatment may be too restrictive for some opioid-dependent people, and may be contributing to the use of illicit buprenorphine. New models to deliver buprenorphine treatment may address these problems.

Buprenorphine in the United States: Motives for abuse, misuse, and diversion

“…1). Two qualitative studies did not provide numeric information that would allow estimation of rates of abuse or misuse; results from those studies are described in text only (Allen & Harocopos, 2016;Sohler et al, 2013). Individual studies varied in how they reported definitions of abuse and misuse.…”

“…For people who are ready to enter treatment, street-purchased buprenorphine was a useful emergency measure given the waiting time of initiating buprenorphine treatment in clinics". (Sohler et al, 2013) Another qualitative study that recruited 42 individuals engaging in non-medical opioid analgesic use and non-prescribed use or diversion of buprenorphine in New York City reported that "there was no discussion of peers promoting buprenorphine use for euphoric effect" (Allen & Harocopos, 2016). Rather, "many participants described using non-prescribed buprenorphine to control or moderate withdrawal symptoms," and "some participants reported fully detoxifying from all opioids through a self-managed buprenorphine taper."…”

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

“…Jones et al, 1994;Koester et al, 1999;Murphy & Irwin, 1992;Neale, 1998Neale, , 1999aSohler et al, 2013).…”

Illicit buprenorphine use, interest in and access to buprenorphine treatment among syringe exchange participants

“…Existing data suggest that many illicit buprenorphine users take diverted buprenorphine to reduce symptoms of opioid withdrawal, not for intoxication or euphoria; thus, illicit buprenorphine use may in part be due to lack of access to BMT (Bazazi et al, 2011; Genberg et al, 2013; Gwin Mitchell et al, 2009; Lofwall & Havens, 2012; Monte et al, 2009; Sohler et al, 2013). Among BMT patients, prioir illicit buprenorphine use has not been associated with negative treatment outcomes (Cunningham et al, 2013), and clinical experience suggests that PWUD attempt to cut down or stop using opioids with illicit buprenorphine for a period of time before they actually initiate BMT.…”