Context: Opioid agonist therapy (OAT) is used worldwide to treat opioid use disorder (OUD). Integrating OAT into primary care has been proposed to improve patient accessibility. The degree of prescribing regulation in primary care varies by country; those with more restrictions may draw upon experiences and outcomes (e.g. overdose mortality reduction) from less restrictive countries to promote relaxed prescribing. However, OAT delivery and any resultant health outcomes may be dependent on broader sociocultural, political, health system, and epidemiological factors.
Rationale The 2007 article ‘Why buprenorphine is so successful in treating opiate addiction in France’ has been widely cited to promote various solutions to growing opioid‐related harms across multiple jurisdictions globally. However, selective promotion of aspects of the French experience or promotion of the French experience without considering relevant contextual factors may inform policies that will not bring the same outcomes as in France, including the introduction of possible unintended negative consequences. The scientific literature is one important arena in which policy solutions are identified, evaluated, promoted and disseminated. Scientific communication of the French opioid use disorder care model offers a timely and relevant example through which to examine how problem representations travel and to consider the effects of these representations. Aims and Objectives We aimed to explore where, when, and how the content of this 2007 index article has travelled through the scientific literature. Method Informed by Bacchi's understanding of problem representation, we conducted a scientometric analysis of the index article. This included categorical analyses using a combination of citation metadata and content data to identify patterns across locations and time. Results Researchers in the United States and Anglophone countries affirmatively cited specific index study content, namely less stringent regulations and positive outcomes, such as reductions in overdose deaths and increases in buprenorphine utilization. These citations were more common after 2015 and were more likely to be in discussion sections of nonempirical publications. Researchers from France cited similar content but did so nonaffirmatively, and throughout the study period. Likewise, the French citations were mostly agenda‐setting citations in the introductory sections of empirical studies. US studies received the highest attention based on number of citations and Altmetric scores. Conclusion US studies, by focusing on less stringent buprenorphine regulation as the primary solution of concern, have constructed opioid‐related harms as a problem of restrictive regulations for buprenorphine. This selective focus on regulation, as opposed to other aspects of the French Model elucidated in the index article such as changes pertaining to the values and financing that structure health service delivery, represents an important missed opportunity for evidence‐informed policy learning across jurisdictions.
Objectives: Opioid agonist therapy using buprenorphine is one of the most effective treatments for opioid use disorder. However, concerns regarding its extramedical use and diversion, such as adverse patient outcomes and damage to the legitimacy of addictions practice, are persistent. The aim of this review is to synthesize the perspectives and experiences of health care providers around the extramedical use of buprenorphine. Methods: A qualitative meta-synthesis was conducted based on a systematic search of 8 databases. All primary qualitative and mixedmethods studies relating to the views of health care providers on the extramedical use of buprenorphine were included. A qualitative analysis informed by the constant comparative method was conducted, using NVivo for data management. Results: Sixteen studies were included in this review. Findings were organizedunder 2 key themes: (1) Harm-producing versus harmreducing effects of extramedical buprenorphine use and (2) driving forces of and responses to extramedical buprenorphine use. Conclusions:The studies included in our review identified a disconnect-health care providers noted that macro, health care system-level challenges drove extramedical use whereas the recommended solutions for prevention and management were primarily aimed at the micro, individual level. This study emphasizes the critical role that health care providers can play, in partnership with patients, in informing appropriate policies and health care system design to optimize the care for people with opioid use disorder.
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