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

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 (P<.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (P<.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.

Anhedonia and Substance Use Disorders by Type, Severity, and With Mental Health Disorders

“…Nonpharmacological explanations for differences in anhedonia forOUDversus other substances are also relevant. Sociocultural factors may make people who use more stigmatized substances (eg, opioids or stimulants) more likely to experience anhedonia compared to those who use other substances, like cannabis, which may be more socially acceptable itself and/or compatible with other socially accepted pleasurable activities 33,34 …”

“…Sociocultural factors may make people who use more stigmatized substances (eg, opioids or stimulants) more likely to experience anhedonia compared to those who use other substances, like cannabis, which may be more socially acceptable itself and/or compatible with other socially accepted pleasurable activities. 33,34 Considering SUD ''severity,'' our coding of AUD severity on the basis of symptom count may be a partial proxy for frequency and intensity of drinking. 35 If so, our findings are consistent with suggestions that drug exposure may dosedependently alter reward processing, although specific doseeffect relationships for alcohol need further characterization.…”

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

“…Along with evidence demonstrating efficacy and established guidelines for prescribing buprenorphine, there is a growing demand for treatment that has exceeded available supply 5 . Numerous studies have illustrated that buprenorphine is largely sought by people who use drugs (PWUD) for treatment of withdrawal symptoms, to reduce or stop use of other opioids, and for pain relief; these motivations are often in the context of an inability to access treatment, driving what has been previously coined “misuse,” “abuse,” or “diversion.” 6 – 14 In this study, we employ the term “alternative use” to avoid any presumptions or judgements about the reasons PWUD may engage in this behavior. This terminology is specific for an individual using buprenorphine in any way that is not intended by the prescriber, including alternate dosing, routes of administration, or means of acquisition.…”

Using Twitter to Surveil the Opioid Epidemic in North Carolina: An Exploratory Study

“…Twitter data have also been mined to study perceptions and attitudes toward opioids [ 20 - 22 ], including those held by specific groups such as youth [ 23 ]. Researchers have used other data streams, including Google Trends to forecast premature death from alcohol, drugs, and suicides [ 24 ]; a cryptomarket forum on the Dark Web to assess the emergence of new psychoactive substances [ 25 ]; and WebMD to explore motivations to use buprenorphine [ 26 , 27 ]. Recently, Graves et al [ 28 ] reported that thematic patterns of opioid-related tweets correlated with opioid overdose rates at the state and county levels.…”