Prior Experience with Non-Prescribed Buprenorphine: Role in Treatment Entry and Retention

Abstract

Buprenorphine availability continues to expand as an effective treatment for opioid dependence, but increases in availability have also been accompanied by increases in non-prescribed use of the medication. Utilizing data from a randomized clinical trial, this mixed-method study examines associations between use of non-prescribed buprenorphine and subsequent treatment entry and retention. Quantitative analyses (N=300 African American buprenorphine patients) found that patients with prior use of non-prescribed buprenorphine had significantly higher odds of remaining in treatment through 6 months than patients who were naïve to the medication upon treatment entry. Qualitative data, collected from a subsample of participants (n=20), identified three thematic explanations for this phenomenon: 1) perceived effectiveness of the medication; 2) cost of obtaining prescription buprenorphine compared to purchasing non-prescribed medication; and 3) convenience of obtaining the medication via daily-dosing or by prescription compared to non-prescribed buprenorphine. These findings suggest a dynamic relationship between non-prescribed buprenorphine use and treatment that indicates potential directions for future research into positive and negative consequences of buprenorphine diversion.

Very early disengagement and subsequent re-engagement in primary care Office Based Opioid Treatment (OBOT) with buprenorphine

“…Increased experience with buprenorphine or the clinic may improve future treatment retention and success. (Cunningham et al, 2013; Monico et al, 2015) This observation suggests the need for better outreach through measures such as telephone-based recovery assistance programs or harm reduction programs to encourage and facilitate treatment re-entry. (Proctor, Wainwright, Herschman, & Kopak, 2017; Shah, BS, Sohler, PhD, MPH, López, BA, Fox, MD, & Cunningham, MD, MS, 2013) Such outreach may ultimately benefit patients by reducing mortality and morbidity associated with being out of treatment.…”

Retention of patients in opioid substitution treatment: A systematic review

“…As outlined in Table 3 . Similarly, three of the six buprenorphine cohorts reported significant effects, with cocaine associated with reduced retention [56,58,71]. A smaller number of studies reported significant effects for benzodiazepines; two [75,76] of the six MMT cohorts reported illicit benzodiazepine use was associated with reduced retention.…”

“…The majority of the observational studies involved a retrospective cohort study design (n = 37) PLOS ONE [37, 39, 42-44, 46, 49-54, 58, 59, 63, 64, 68-70, 72-74, 76, 79-82, 84-87, 89-91, 93, 94, 97], with prospective cohort studies accounting for a further 23 studies [35, 36, 38, 40, 41, 45, 47, 48, 55, 57, 60-62, 65-67, 75, 77, 78, 83, 87, 88, 97]. The remaining three studies involved an ambidirectional cohort study [95] and analyses of data collected as part of an RCT [56,71].…”

“…There was a large range of treatment settings, with OST clinics accounting for the largest proportion of treatment settings at 53.7% (n = 36) [31, 33-39, 42, 45, 46, 48-51, 53, 55, 57, 60, 62, 64, 66, 67, 75-81, 83, 92, 94-97]. Other treatment settings included office based or primary care OST (n = 9) [32,40,47,58,82,84,87,88,93], hospital setting (n = 5) [61,63,65,85,91], outpatient treatment programmes (n = 4) [54,56,71,72] and mixed treatment settings (n = 3) [41,44,73]. The remaining studies reported on national or regional registries, including health insurance databases (n = 10) [43,52,59,69,74,86,89,90] or Veteran Health Administration records in the US [68,70].…”

Buprenorphine in the United States: Motives for abuse, misuse, and diversion

“…Survey results from smaller samples of people seeking or receiving OUD treatment were consistent with these larger samples, with reports of buprenorphine misuse more frequent than for abuse. A qualitative study of 20 adults being admitted into a buprenorphine-based MAT program reported 75% had used non-prescribed buprenorphine prior to starting MAT (Monico et al, 2015). The authors concluded that the primary motive for misuse was to prevent the onset of opioid withdrawal, since "none of the respondents mentioned seeking or using buprenorphine with the intention of 'getting high' and, in fact, made a clear distinction between seeking heroin to 'get high' and seeking buprenorphine to stop 'physical pain,' 'not be sick that day,' or 'hold' them until they were able to acquire quality heroin.…”