Alternative use of Buprenorphine among People who use Opioids in Three U.S. Cities

Abstract

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.

Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems

“…Intersectionality is an analytic framework for investigating how different systems of power and oppression operate together to form complex social inequities such as the unique health inequities of people who are both racially and ethnically marginalized and face stigma because of their addiction 59,60 . Future research in the care of patients with OUD in the ED should expand the use of an intersectionality framework to explore how systems of power in patients with OUD, including race, ethnicity, gender, class, and pregnancy impact all levels of treatment, including access to care, use of medications, referrals and admissions as we continue to address the health inequities, and the inherent stigma and bias that perpetuates distrust in the health care system 61 …”

“… 59 , 60 Future research in the care of patients with OUD in the ED should expand the use of an intersectionality framework to explore how systems of power in patients with OUD, including race, ethnicity, gender, class, and pregnancy impact all levels of treatment, including access to care, use of medications, referrals and admissions as we continue to address the health inequities, and the inherent stigma and bias that perpetuates distrust in the health care system. 61 …”

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

“…35 Buprenorphine is relatively safe with minimal risk for acute overdose death, and surveys demonstrate that, as with methadone, even diverted buprenorphine is typically used for therapeutic purposes. [36][37][38][39][40][41] Both methadone and buprenorphine are similarly effective in treating OUD. 19,20,26,27 Naltrexone, a mu opioid receptor antagonist, is available in both oral and long-acting injectable formulations.…”