Injecting buprenorphine‐naloxone film: Findings from an explorative qualitative study

Abstract

Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the 'gelatine like' texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices.

A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program

“…The volume of buprenorphine arrests, especially for trafficking, might appear concerning, particularly due to its primary indication for the treatment of individuals who are addicted to opioids in conjunction with reports of misuse . We postulate that although buprenorphine may be used for euphoria in some buprenorphine‐naive patients, most buprenorphine is being used in those who are self‐treating symptoms of withdrawal in the context of an opioid use disorder; therefore, our data illustrate the need for increased access to prescribed and monitored buprenorphine therapy and associated psychosocial treatments.…”

“…The volume of buprenorphine arrests, especially for trafficking, might appear concerning, particularly due to its primary indication for the treatment of individuals who are addicted to opioids 11 in conjunction with reports of misuse. 2,3 We postulate that although buprenorphine may be used for euphoria in some buprenorphine-naive patients, most buprenorphine is being used in those who are self-treating symptoms of withdrawal in the context of an opioid use disorder; therefore, our data illustrate the need for increased access to prescribed and monitored buprenorphine therapy and associated psychosocial treatments. Because buprenorphine was responsible for almost all Schedule III arrests and the second highest prescription drug, behind only oxycodone, for drug arrests in the first quarter of 2016, naltrexone extendedrelease injectable suspension, in addition to buprenorphine, should be considered for preferred drug status by private and state health insurance plans.…”

“…A variety of strategies are currently already in place or are being optimized to combat the opioid epidemic. These include implementing state Prescription Drug Monitoring Programs (PDMPs) nationally and improving their interstate data sharing and usability, maximizing participation in drug take‐back programs, greatly increasing the availability of short‐acting opioid antagonists (naloxone), developing more difficult to abuse opioids, implementing more judicial and cautious opioid prescribing, and realigning patient expectations regarding pain management. Although the quality of data is generally low, empirical evaluations of some of these interventions have been underwhelming thus far.…”

Ischemic Hand Complications From Intra-Arterial Injection of Sublingual Buprenorphine/Naloxone Among Patients With Opioid Dependency

“…The most common method for parenteral abuse is to dissolve the strips in a variable amount of water, filter the solution, and then inject the medication intravenously. 12 In recent years, the hand surgery team at the University of Kentucky Medical Center has noted an increasing number of patients presenting to the emergency room or outpatient clinics with ischemia of the hand and digits after inadvertent or intentional intra-arterial injection of sublingual BNX. When looking to the literature for guidance on the management of these patients, we found that very little had been written about these injuries.…”

Notes from the Field: Emergency Visits for Complications of Injecting Transmucosal Buprenorphine Products — United States, 2016–2018

“…The opioid partial agonist buprenorphine is a critical component of medication-assisted treatment for opioid use disorder and is associated with improved treatment adherence and decreased illicit opioid use ( 1 ). Combination buprenorphine/naloxone transmucosal products are designed to deter injection owing to the opioid-antagonist actions of naloxone and can reduce the desired effects and precipitate rapid withdrawal when these products are administered intravenously; nonetheless, injection of transmucosal buprenorphine/naloxone has been reported ( 2 , 3 ). During 2016–2017, 14.6% of approximately 127,000 emergency department (ED) visits for nonmedical use * of prescription opioids involved buprenorphine products, commonly for injection-related complications ( 4 ).…”