On my own terms: Motivations for self-treating opioid-use disorder with non-prescribed buprenorphine

Silverstein, Sydney M.; Daniulaityte, Raminta; Miller, Shannon C.; Martins, Sílvia S.; Carlson, Robert G.

doi:10.1016/j.drugalcdep.2020.107958

Cited by 44 publications

(45 citation statements)

References 62 publications

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“…But like all medication treatments for chronic conditions, it is most effective with prolonged and consistent therapeutic use. It is generally understood that the use of nonprescription buprenorphine is an attempt to self-treat withdrawal symptoms associated with opioid dependence, which is facilitated by buprenorphine's low risk of adverse events, a safety profile as a partial agonist, and greater availability [54][55][56][57]. Prior studies have reported a lower risk of NFOD with non-prescribed buprenorphine use [34,56], though neither were conducted in places where or during periods when fentanyl was the dominant opioid being consumed.…”

Section: Discussionmentioning

confidence: 99%

“…As we are unable to establish temporality due to the cross-sectional nature of the study design, it is difficult to disentangle whether the withdrawal symptoms may have played in mediating NFOD risk. It is possible that individuals who have had prior overdoses may be motivated to utilize non-prescribed buprenorphine as a means to reduce their risk of overdose and also serve as the first step to initiation of formal treatment [54][55][56]. The utilization of nonprescription of buprenorphine represents a complex dynamic of interaction between people with OUD and their substance use behaviors, substance use treatment providers, substance use treatment policy, and rurality.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

et al. 2021

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Background People who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. With unprecedented increases in fentanyl in the US drug supply, many Massachusetts (MA) communities have seen a surge in opioid-related overdoses. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-risk MA communities. Methods We conducted multiple rapid assessments among people who use drugs (PWUD) in eight MA communities using non-probability sampling (purposive, chain referral, respondent-driven) methods. We collected sociodemographic, substance use, overdose history, substance use treatment, and harm reduction services utilization data. We examined the prevalence of NFOD (lifetime and past year) and identified factors associated with NFOD through multivariable logistic regression analyses in a subset of 469 study participants between 2017 and 2019. Results The prevalence of lifetime and last year non-fatal opioid overdose was 62.5% and 36.9%, respectively. Many of the study participants reported heroin (64%) and fentanyl (45%) use during the 30 days preceding the survey. Nonprescription buprenorphine and fentanyl use were independently associated with higher odds of lifetime NFOD, while marijuana use was associated with lower odds of lifetime NFOD (p < 0.05). Injection as the route of administration, benzodiazepine, nonprescription buprenorphine, heroin, and fentanyl use were independently associated with higher odds, while methadone use was associated with lower odds of past year NFOD (p < 0.05). Conclusion We documented a high prevalence of past year and lifetime NFOD among PWUD in MA. Our findings provide indicators that can help inform interventions to prevent overdoses among PWUD, including overdose prevention, medication treatment, and naloxone distribution.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

et al. 2021

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“…21 For these reasons, some OUD patients report difficulties in obtaining prescriptions for, and limited access to reliable sources of buprenorphine. 22 Although evidence suggests that individuals who non-medically use diverted buprenorphine do so in ways that align with therapeutic use, [12][13][14] reports of non-medical use of buprenorphine to achieve euphoria are cause for concern. A recent naturalistic study of polysubstance users notes that more than 90% of individuals who engaged in non-medical use of diverted buprenorphine did so as a substitute until their preferred drug could be obtained, and a majority of these same individuals also reported doing so to get high.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Qualitative descriptions of motivations for non-medical use of diverted buprenorphine for selftreatment include: avoiding the perceived demands and burdens of formal treatment settings; initiating recovery episodes while waiting for treatment to become available or psychologically preparing for formal treatment; and expressing autonomy and bolstering one's feelings of determination during the recovery process. 14 Despite ongoing reports of the non-medical use of diverted buprenorphine, data related to diversion are scarce. Moreover, systematic data describing diversion rates at the national level are not apparent.…”

Section: Introductionmentioning

confidence: 99%

Increasing rates of buprenorphine diversion in the United States, 2002 to 2019

Buttram

Kurtz

Margolin

et al. 2021

Pharmacoepidemiology and Drug

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Purpose: Recent reports suggest that buprenorphine is being diverted and used nonmedically. However, no apparent studies have reported national-level data on buprenorphine diversion.Methods: Case report data were drawn from a quarterly survey of prescription drug diversion completed by a national sample of law enforcement and regulatory agencies who engage in drug diversion investigations. Quarterly rates of buprenorphine diversion per 100 000 population and 100 000 prescriptions dispensed were calculated for the period 2002 through 2019. Population-based diversion rates were also calculated by U.S. region.Results: In total, 9670 cases of diverted buprenorphine were reported across all 50 states and the District of Columbia during the study period. Buprenorphine diversion rates, per 100 000 population, were characterized by an accelerating increase over time; increases in diversion rates from 1st quarter 2002 through 4th quarter 2006 were not statistically significant, yet from 1st quarter 2007 through 4th quarter 2019, the rate of diversion cases increased by 0.0067 cases per 100 000 per quarter (p < 0.001). Buprenorphine diversion rates per 100 000 prescriptions dispensed indicated a gradual increase over time; from 3rd quarter 2010 through 4th quarter 2019, diversion rates showed a statistically significant increase of 0.28 cases (p = 0.037) per quarter on average. The Northeast was the only region that did not observe an increase in the average quarterly change in buprenorphine diversion rates after 2006.Conclusions: Findings from this study illustrate longitudinal national trends of increasing buprenorphine diversion. Continued systematic surveillance of this phenomenon is needed.

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“…As with all medications, diversion of buprenorphine does occur. But research has increasingly found that patients use diverted buprenorphine therapeutically (Silverstein et al, 2020), and it may have some beneficial effects in the community (Carlson et al, 2020). The safety profile of buprenorphine, along with the therapeutic use of diverted medication, has led some to argue that it should be available without a prescription (Roy & Stein, 2019).…”

mentioning

confidence: 99%

Down the drain: Reconsidering routine urine drug testing during the COVID-19 pandemic

Pytell

Rastegar

2021

Journal of Substance Abuse Treatment

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The COVID-19 pandemic and the move to telemedicine for office-based opioid treatment have made the practice of routine urine drug tests (UDT) obsolete. In this commentary we discuss how COVID-19 has demonstrated the limited usefulness and possible harms of routine UDT. We propose that practitioners should stop using routine UDT and instead use targeted UDT, paired with clinical reasoning, as part of a patient-centered approach to care.

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On my own terms: Motivations for self-treating opioid-use disorder with non-prescribed buprenorphine

Cited by 44 publications

References 62 publications

Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

Increasing rates of buprenorphine diversion in the United States, 2002 to 2019

Down the drain: Reconsidering routine urine drug testing during the COVID-19 pandemic

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