Individual and structural correlates of willingness for intravenous buprenorphine treatment among people who inject sublingual buprenorphine in France

Abstract

Background Some people do not benefit from oral administration of opioid agonist treatment, and an intravenous (IV) formulation may be more suitable. Our objective was to evaluate the willingness of people who regularly inject sublingual buprenorphine to receive IV buprenorphine as a prescribed treatment, and to examine related correlates. Methods We performed a secondary analysis of data from the cross-sectional study PrebupIV, conducted in France in 2015 among 557 people who inject opioids. The study comprised questionnaires completed either face to face or online and community-based workshops. We only included participants who reported buprenorphine as their main injected drug (n = 209). Willingness to receive IV buprenorphine treatment was measured on a scale from 0 to 10. Ordinal logistic regression identified correlates of willingness. Artworks and testimonies from participants in the workshops were also used to illustrate correlates of willingness. Results Among the 209 participants, the mean score (SD) for willingness to receive IV buprenorphine was 8.0 (2.8). Multivariate analysis showed that participants who reported using non-prescribed buprenorphine (AOR = 4.82, p = 0.019), a higher daily dosage of buprenorphine (AOR (for 1 mg) = 1.05, p = 0.043), and a higher number of complications due to injection (AOR = 2.28, p = 0.037), were more willing to receive IV buprenorphine treatment. Conclusions Willingness to initiate IV buprenorphine treatment was high among people who regularly inject sublingual buprenorphine. A prescribed IV formulation could attract and retain more people into care and reduce harms associated with the injection of buprenorphine tablets.

“I can’t see anything but upside”: A qualitative study of clients’ experiences on North America’s first take-home injectable opioid agonist treatment (iOAT) program

“…For example, they describe take-home doses as a form of equity and accessibility in their treatment, as the time and expense of getting to the clinic multiple times a day was a major challenge to remain engaged in care, similar to prior research on methadone (22). Prior research indeed indicates that the intensity of iOAT (e.g., multiple daily in-person appointments) is a deterrent for potential clients to want to engage in the program (72,73). Not surprisingly, participants reported that the demanding schedule of appointments made them consider returning to the illicit market, which aligns with previous research shows that clients will return to the illicit market if treatment is not accessible (74).…”

People who inject oral morphine favor experimentation with injectable opioid substitution

“…This apprehension could be reduced by making it possible to prescribe an injectable opioid substitution, within a clear legal framework, and improving the education of health professionals regarding the needs of PWIM, particularly young adults. As one study of injectable buprenorphine showed, the people most in favor of injectable treatment were those who never received prescriptions for their substance use disorder [ 23 ]. The availability of an injectable substitution would be an ideal entry point for the management of opioid use disorder and appropriate HR measures [ 23 , 24 ].…”

“…As one study of injectable buprenorphine showed, the people most in favor of injectable treatment were those who never received prescriptions for their substance use disorder [ 23 ]. The availability of an injectable substitution would be an ideal entry point for the management of opioid use disorder and appropriate HR measures [ 23 , 24 ]. As young adults appear to be the most precarious people concerned, and therefore the least able to finance their care, it is necessary to facilitate their access to OST, including injectable forms, covered by the national health system [ 18 , 19 , 25 ].…”

“…These structures have also been shown to reduce systemic viral infections (HIV and HCV), skin complications due to injections, non-fatal overdoses, and emergency room visits [ 38 ]. However, care must be taken to ensure that the care framework is sufficiently non-stigmatizing, flexible and respectful of confidentiality to avoid a coercive and restrictive dimension that would undermine its attractiveness and effectiveness, especially in young adults [ 18 , 20 , 23 , 24 , 39 ].…”