Willingness to receive intravenous buprenorphine treatment in opioid-dependent people refractory to oral opioid maintenance treatment: results from a community-based survey in France

Abstract

BackgroundInjectable opioids are an interesting option for people who inject drugs (PWID) that do not respond to oral Opioid Maintenance Treatment (OMT). To date, intravenous (IV) buprenorphine - a safer drug than full-opioid agonists in terms of overdose risk - has never been tested in a clinical trial on opioid dependence. We designed a survey to better understand the profile of PWID eligible for IV buprenorphine, and their willingness to receive it.MethodsThis cross-sectional community-based national survey was conducted through face-to-face interviews (in low-threshold and addiction care services) and online questionnaires (on https://psychoactif.org and other websites). Among the 557 participants, we selected those who were eligible for IV buprenorphine treatment (history of oral OMT, regular opioid injection) (n = 371). We used regression models to study factors associated with willingness to receive IV buprenorphine treatment among those with data on willingness (n = 353). In those who were willing (n = 294), we subsequently studied their willingness to receive daily supervised IV buprenorphine treatment.ResultsAmong the selected 353 participants, 59% mainly injected buprenorphine, 15% heroin, 16% morphine sulfate and 10% other opioids. Eighty-three percent of the sample reported willingness to receive IV buprenorphine treatment. Factors associated with willingness were: more than 5 injection-related complications, regular buprenorphine injection, no lifetime overdose, and completion of the questionnaire online. Factors associated with unwillingness to receive daily supervised treatment were younger age (OR[IC95%]=1.04[1.01; 1.07]) and stable housing (OR[IC95%]=0.61[0.37;1.01]) while regular heroin injectors were more willing to receive daily supervision (OR[IC95%]=2.94 [1.42; 6.10]).ConclusionsPWID were very willing to receive intravenous buprenorphine as a treatment, especially those with multiple injection-related complications. In addition, our findings show that IV buprenorphine may be less acceptable to PWID who inject morphine sulfate. Young PWID and those with stable housing were unwilling to receive IV buprenorphine if daily supervision were required. This preliminary study provides useful information for the development of a clinical trial on IV buprenorphine treatment.

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

“…This is the reason why public health researchers, clinical experts and the PWID community, came together in 2015 to set up a project to evaluate the feasibility and efficacy of IV buprenorphine as a prescribed treatment in France. The first step of this project was to implement a community-based research study, entitled PrebupIV, to characterize people who inject opioids, and to evaluate their willingness to receive this potential treatment [ 22 ]. The community-based aspect of PrebupIV focused on involving people who inject opioids in the development of IV buprenorphine as a treatment, through their participation in the research process and dissemination of the results.…”

Factors associated with perceived loss of libido in people who inject opioids: Results from a community-based survey in France

“…The choice to take morphine sulfate instead of other OST may be related to its stronger "high" effect and this may be the reason for the greater loss of libido reported in this population. The PrebupIV survey (Roux et al, 2017) showed that morphine sulfate was used to get high more frequently than methadone and buprenorphine. Another French survey investigating this substance reported that 77.6% of users were searching for a rewarding effect (Peyriere et al, 2016).…”

“…PrebupIV is a cross-sectional community-based participatory research study performed by the association AIDES and the French national institute for medical research (INSERM) in collaboration with other associations (Fédération Addiction, ASUD, Médecins du Monde). Its aim was to assess acceptability of a novel intravenous buprenorphine treatment (Roux et al, 2017). It was conducted in France between May and August 2015 in low-threshold addiction centers (free centers which provide various services, including needle exchange programs, where no requirements are needed for attendance), in general practitioner offices, in community-based associations, and through the French drug-use self-help website Psychoactif.org.…”

“…), reasons for using drugs by injection, perceived complications (including loss of libido); 3) acceptability of a novel intravenous buprenorphine treatment, associated preferences for the type of injecting system (simple vial with syringe or pre-filled syringe) for this treatment and acceptability of daily IV buprenorphine treatment doses. More details are available in Roux et al, 2017. Loss of libido was one of 14 possible responses to the question related to complications arising from drug injection: "Have you had any of the following complications because of drug injection?…”

“…Few studies have examined loss of libido in different populations of people who inject opioids (Yee et al, 2014). The present secondary analysis of the community-based survey PrebupIVinitially conducted to assess the willingness of people who inject drugs (PWID) frequently to receive a novel intravenous buprenorphine treatment (Roux et al, 2017)enabled us to explore libido, which is rarely discussed with health professionals or field workers or indeed in the drug user community. Factors associated with loss of libido, and more particularly, the impact of the type of opioid injected, may provide clues to field workers about how to talk about sexuality, and to doctors about which OST to prescribe.…”