Drug-Related Harm According to Opiate Users on Buprenorphine Treatment

Abstract

Aims The purpose of this article is to analyse the meanings given to substances as intoxicants, medicine and treatment from the client perspective in buprenorphine treatment. How do the clients construct drug-related harms and how do they act to reduce the harms? Methods The material is ethnographic and consists of participant observation and client interviews. The data is gathered from an institutional treatment facility offering buprenorphine treatment. Clients stressed the excitement of heroin use as opposed to the safety of buprenorphoine. The negative aspects of amphetamins are strongly emphasised. They did not justify the need for substitution therapy. The negative effects of heroin had a dual meaning in that they also assigned a positive user identity and justified the need for medication. The safety aspect of burprenorphine was linked to nonexistent overdose risk and to difficulty in tracing the substance in urine tests. The function of burprenorphine as an intoxicant was to restrict the harm resulting from the use of other intoxicants. The clients in substitution treatment emphasised the positive effect of buprenorfine as a medicine while those in detox emphasised the negative effects. Treatment itself receives positive meaning when it offers belief in achieving the personal treatment goal and negative meaning if it fails to do so. Conclusion The dual political role of bruprenorphine as a life saving medication and an evil drug complicates the status and role of clients in buprenorphine treatment.

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

“…PWUD who selfmedicated with buprenorphine stated that it enabled them to reduce or completely stop other opioid use (Brown & Altice, 2014;Bruce et al, 2008;Cicero et al, 2014;Daniulaityte et al, 2012;Furst, 2013Furst, , 2014Havnes et al, 2013;Kavanaugh & McLean, 2020;Monico et al, 2015;Monte et al, 2009;Pedersen et al, 2017;Silverstein et al, 2019Silverstein et al, , 2020. Their motivations included a desire to avoid withdrawal symptoms, a fear of overdose from their regular opioid use, and concern about resuming use of other opioids such as heroin (Brown & Altice, 2014;Bruce et al, 2008;Cicero et al, 2014;Daniulaityte et al, 2012;Furst, 2013;Havnes et al, 2013;Kavanaugh & McLean, 2020;Monico et al, 2015;Silverstein et al, 2020;Weckroth, 2007).…”

“…○ an attractive alternative to OAT ○ a stepping-stone to OAT ○ a way of deal with waiting lists ○ a saving resource in case of involuntary discharge • Self-medication often began as a result of a wish to change their life situation or to cut back on heroin (continued on next page) Daniulaityte et al, 2012;Havnes et al, 2013;Monico et al, 2015;Monte et al, 2009;Silverstein et al, 2019;Weckroth, 2007). Some described extramedical buprenorphine as "lifesaving", allowing them to continue recovery after being involuntarily discharged from formal treatment .…”

“…Ten studies reported that PWUD took extramedical buprenorphine to "get high", for example, when preferred drugs such as heroin were unavailable (Bruce et al, 2008;Cicero et al, 2014;Daniulaityte et al, 2012;Furst, 2014;Kavanaugh & McLean, 2020;Monte et al, 2009;Pedersen et al, 2017;Weckroth, 2007). While some reported experiencing very intense, enjoyable, and long-lasting effects, others were disappointed by their experiences, blaming their high tolerance to other opioids (Bruce et al, 2008;Daniulaityte et al, 2012;Weckroth, 2007). Others were able to "get high" by using buprenorphine with substances such as cannabis and benzodiazepines (Bruce et al, 2008;Kavanaugh & McLean, 2020;Pedersen et al, 2017;Weckroth, 2007).…”

“…While some reported experiencing very intense, enjoyable, and long-lasting effects, others were disappointed by their experiences, blaming their high tolerance to other opioids (Bruce et al, 2008;Daniulaityte et al, 2012;Weckroth, 2007). Others were able to "get high" by using buprenorphine with substances such as cannabis and benzodiazepines (Bruce et al, 2008;Kavanaugh & McLean, 2020;Pedersen et al, 2017;Weckroth, 2007). Similar to use for self-medication, some PWUD preferred bup-nal films to heroin to "get high" because of their lower likelihood of being adulterated (Kavanaugh & McLean, 2020).…”

“…PWUD in several studies indicated that experiences with extramedical buprenorphine increased their willingness to enter and remain in OAT (Cicero et al, 2014;Monico et al, 2015;Silverstein et al, 2019Silverstein et al, , 2020Weckroth, 2007). In Monico et al (2015), the three main factors that motivated users of extramedical buprenorphine to enroll in OAT were the perceived effectiveness of the medication, the lower relative cost of prescription buprenorphine (especially through insurance coverage and subsidies), and the convenience of obtaining the medication by prescription.…”