How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users (Preprint)

Abstract

BACKGROUND Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users’ motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one’s own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. OBJECTIVE The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. METHODS Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. RESULTS Among all posts, 0.81% (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (<i>P</i><.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (<i>P</i><.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76%), although much less often than in oxycodone ER posts (425/508, 83.7%). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. CONCLUSIONS An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts.

Automedicación con uso recreativo: Análisis de discusiones en foros de una comunidad virtual

“…En relación con el fenómeno de la automedicación, el escenario virtual puede ser un campo relevante para entender el comportamiento humano y sus interacciones en el ciberespacio relacionados con estas conductas, en las que existen diversos sitios web (por ejemplo: chat, foros, blogs, comunidades de valoración de productos, comunidades de opinión, comunidades de marca, redes sociales). En estos espacios, las personas no solo expresan sus percepciones respecto a determinadas necesidades de medicación o percepciones sobre productos y servicios médicos, sino que también expresan motivaciones, inquietudes, problemas, entre otros (Butler et al, 2020;Holtz, Kronberger & Wagner, 2012). En este entramado de interacciones, aparecen diversos factores que pueden orientar, moldear e incluso influenciar la toma de decisiones para la automedicación.…”

“…Esta dinámica se puede presentar no sólo en aquellas personas que publican contenido relacionado con una sustancia en particular, o sobre la actividad del consumo en general, sino también de aquellas personas que son simplemente observadoras o lectores del contenido. En este último caso, aunque las personas no tienen un papel activo en la discusión pueden contribuir a la difusión de ese contenido mediante otros canales (Butler et al, 2020).…”

“…Algunas de las razones que se han expuesto en la literatura son que estos escenarios favorecen que los miembros compartan información y escriban, sin censura, sus experiencias sobre el consumo de drogas de manera más o menos anónima (ej. Chary & Manini, 2018;Butler et al, 2020;Davey, et al, 2012;, Soussan, & Kjellgren, 2014. En la literatura se ha reportado que en estos espacios los miembros comparten conocimientos, opiniones de temas que se perciben como menos aceptados en el entorno físico y se ha hablado de la relevancia y la funcionalidad que tienen este tipo de canales al contar con una base de almacenamiento de datos que permite recuperar las publicaciones que se han hecho a lo largo de los años, facilitando la evaluación retrospectiva de los datos (Butler et al 2020).…”