Background: Buprenorphine is an effective treatment for opioid use disorder, yet some persons are concerned with its “alternative use” (i.e., any use unintended by the prescriber). There is limited evidence on the factors associated with alternative use of buprenorphine (AUB); in this study, we examined correlates of recent (past 6 months) AUB. Methods: Multivariable logistic regression was used to analyze survey data from a multi-site, cross-sectional study of people who use drugs (PWUD) (N = 334) in Baltimore, Maryland; Boston, Massachusetts; and Providence, Rhode Island. Results: One-fifth (20%) of the sample reported recent AUB. In adjusted analyses, significant negative correlates of AUB were female gender (adjusted odds ratio [aOR] 0.48, 95% confidence intervals [CI] 0.24–0.95), recent emergency room visit (aOR 0.45, 95% CI 0.23–0.89), and recent injection drug use (aOR 0.41, 95% CI 0.19–0.88). Significant positive correlates were alternative use of other prescription opioids (aOR 8.32, 95% CI 4.22–16.38), three or more overdoses in the past year (aOR 3.74, 95% CI 1.53–9.17), recent buprenorphine use as prescribed (aOR 2.50, 95% CI 1.12–5.55), and recent residential rehabilitation treatment (aOR 3.71, 95% CI 1.50–9.16). Conclusions: Structural and behavioral correlates of AUB may help identify PWUD at high risk of overdose with unmet treatment needs.
DydykAM, JainNK, GuptaM.Opioid use disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
2.
AhmadFB, RossenLM, SuttonP.Provisional Drug Overdose Death Counts. National Center for Health Statistics; 2020.
3.
WilsonN, KariisaM, SethP, SmithHIV, DavisNL. Drug and opioid-involved overdose deaths – United States, 2017–2018. MMWR Morb Mortal Wkly Rep. 2020;69(11):290–297.
4.
VelanderJR.Suboxone: rationale, science, misconceptions. Ochsner J. 2018;18(1):23–29.
5.
JonesCM, CampopianoM, BaldwinG, McCance-KatzE.National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015;105(8):e55–e63.
6.
YokellMA, ZallerND, GreenTC, RichJD.Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review. Curr Drug Abuse Rev. 2011;4(1):28–41.
7.
CarrollJJ, RichJD, GreenTC.The more things change: buprenorphine/naloxone diversion continues while treatment remains inaccessible. J Addict Med. 2018;12(6):459–465.
8.
CiceroTJ, EllisMS, ChilcoatHD.Understanding the use of diverted buprenorphine. Drug Alcohol Depend. 2018;193:117–123.
9.
ButlerSF, OyedeleNK, Dailey GovoniT, GreenJL.How motivations for using buprenorphine products differ from using opioid analgesics: evidence from an observational study of internet discussions among recreational users. JMIR Public Health Surveill. 2020;6(1):e16038.
10.
ChilcoatHD, AmickHR, SherwoodMR, DunnKE.Buprenorphine in the United States: motives for abuse, misuse, and diversion. J Subst Abuse Treat. 2019;104:148–157.
11.
SilversteinSM, DaniulaityteR, MillerSC, MartinsSS, CarlsonRG.On my own terms: motivations for self-treating opioid-use disorder with non-prescribed buprenorphine. Drug Alcohol Depend. 2020;210:107958.
12.
Gwin MitchellS, KellySM, BrownBSUses of diverted methadone and buprenorphine by opioid-addicted individuals in Baltimore, Maryland. Am J Addict. 2009;18(5):346–355.
13.
RichertT, JohnsonB.Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden. Harm Reduct J. 2015;12:1.
14.
SchulteB, SchmidtCS, StradaLNon-prescribed use of opioid substitution medication: patterns and trends in sub-populations of opioid users in Germany. Int J Drug Policy. 2016;29:57–65.
15.
GlickJL, ChristensenT, ParkJN, McKenzieM, GreenTC, ShermanSG.Stakeholder perspectives on implementing fentanyl drug checking: results from a multi-site study. Drug Alcohol Depend. 2019;194:527–532.
16.
ShermanSG, MoralesKB, ParkJN, McKenzieM, MarshallBDL, GreenTC.Acceptability of implementing community-based drug checking services for people who use drugs in three United States cities: Baltimore, Boston and Providence. Int J Drug Policy. 2019;68:46–53.
17.
GoldsworthyRC, SchwartzNC, MayhornCB.Beyond abuse and exposure: framing the impact of prescription-medication sharing. Am J Public Health. 2008;98(6):1115–1121.
18.
BeyeneKA, SheridanJ, AspdenT.Prescription medication sharing: a systematic review of the literature. Am J Public Health. 2014;104(4):e15–e26.
19.
NetherlandJ, BotskoM, EganJEFactors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2009;36(3):244–251.
20.
JaffeJH, O'KeeffeC.From morphine clinics to buprenorphine: regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003;70(2 Suppl):S3–S11.
21.
Schuman-OlivierZ, ConneryH, GriffinMLClinician beliefs and attitudes about buprenorphine/naloxone diversion. Am J Addict. 2013;22(6):574–580.
22.
PriestKC.Commentary on Jin et al. (2020): regulatory and allocative policies inform access to opioid agonist therapy. Addiction. 2020;115(12):2255–2256.
23.
MravčíkV, JaníkováB, DrbohlavováB, PopovP, PironaA.The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic. Harm Reduct J. 2018;15(1):60.
24.
Bretteville-JensenAL, LillehagenM, GjersingL, AndreasJB.Illicit use of opioid substitution drugs: prevalence, user characteristics, and the association with non-fatal overdoses. Drug Alcohol Depend. 2015;147:89–96.
25.
DaniulaityteR, NahhasRW, SilversteinSPatterns of non-prescribed buprenorphine and other opioid use among individuals with opioid use disorder: a latent class analysis. Drug Alcohol Depend. 2019;204:107574.
26.
CarlsonRG, DaniulaityteR, SilversteinSM, NahhasRW, MartinsSS.Unintentional drug overdose: is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose?Int J Drug Policy. 2020;79:102722.
27.
KrawczykN, MojtabaiR, StuartEAOpioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services. Addiction. 2020;115(9):1683–1694.
28.
WightmanRS, PerroneJ, ScagosR, KriegerM, MarshallBDL, NelsonLS.Opioid overdose deaths with buprenorphine detected in postmortem toxicology: a retrospective analysis. J Med Toxicol. 2021;17(1):10–15.
29.
ParkTW, SaitzR, GanoczyD, IlgenMA, BohnertAS.Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ. 2015;350:h2698.
30.
SunEC, DixitA, HumphreysK, DarnallBD, BakerLC, MackeyS.Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ. 2017;356:j760.
31.
JonesJD, MogaliS, ComerSD.Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1–2):8–18.
32.
AllainF, MinogianisEA, RobertsDC, SamahaAN.How fast and how often: the pharmacokinetics of drug use are decisive in addiction. Neurosci Biobehav Rev. 2015;56:166–179.
33.
ChenY, WangY, NielsenS, KuhnL, LamT.A systematic review of opioid overdose interventions delivered within emergency departments. Drug Alcohol Depend. 2020;213:108009.
34.
NealeJ, StevensonC.Social and recovery capital amongst homeless hostel residents who use drugs and alcohol. Int J Drug Policy. 2015;26(5):475–483.
35.
PettersenH, LandheimA, SkeieIHow social relationships influence substance use disorder recovery: a collaborative narrative study. Subst Abuse. 2019;13:1178221819833379.
36.
NealeJ, TompkinsCNE, StrangJ.Qualitative exploration of relationships between peers in residential addiction treatment. Health Soc Care Community. 2018;26(1):e39–e46.
37.
WestonS, HonorS, BestD.A tale of two towns: a comparative study exploring the possibilities and pitfalls of social capital among people seeking recovery from substance misuse. Subst Use Misuse. 2018;53(3):490–500.
38.
McCartyD, PriestKC, KorthuisPT.Treatment and prevention of opioid use disorder: challenges and opportunities. Annu Rev Public Health. 2018;39:525–541.
39.
Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS).2017. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.
40.
HemsingN, GreavesL, PooleN, SchmidtR.Misuse of prescription opioid medication among women: a scoping review. Pain Res Manag. 2016;2016:1754195.
41.
KoonsAL, Rayl GreenbergM, CannonRD, BeauchampGA.Women and the experience of pain and opioid use disorder: a literature-based commentary. Clin Ther. 2018;40(2):190–196.
42.
Centers for Disease Control and Prevention. Vital signs: overdoses of prescription opioid pain relievers and other drugs among women–United States, 1999–2010. MMWR Morb Mortal Wkly Rep. 2013;62:537–542.
43.
VanHoutenJ, RuddRA, BallesterosMF, MackKA. Drug overdose deaths among women aged 30–64 Years – United States, 1999–2017. MMWR Morb Mortal Wkly Rep. 2019;68(1):1–5.
44.
Nguemeni TiakoMJ.Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19. J Subst Abuse Treat. 2021;122:108214.
45.
JamesK, JordanA.The opioid crisis in black communities. J Law Med Ethics. 2018; 46(2):404–421.
46.
HansenHB, RobertsSK.Two tiers of biomedicalization: methadone, buprenorphine, and the racial politics of addiction treatment. Crit Perspect Addict. 2012;14:79–102.
47.
OlsenY, SharfsteinJM. Confronting the stigma of opioid use disorder-and its treatment. JAMA. 2014;311(14):1393–1394.
48.
MacleanJC, SalonerB.The effect of public insurance expansions on substance use disorder treatment: evidence from the Affordable Care Act. J Pol Anal Manage. 2019;38(2):366–393.
49.
DickAW, PaculaRL, GordonAJGrowth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002–11. Health Aff (Millwood). 2015;34(6):1028–1034.
50.
ShulmanM, WaiJM, NunesEV.Buprenorphine treatment for opioid use disorder: an overview. CNS Drugs. 2019;33(6):567–580.
51.
MacleanJC, WenH, SimonKI, SalonerB.Institutions for mental diseases medicaid waivers: impact on payments for substance use treatment facilities. Health Aff (Millwood). 2021;40(2):326–333.
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