Self-Management of Buprenorphine/Naloxone Among Online Discussion Board Users

Abstract

Background Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. Objectives To identify facilitators of self-treatment by online buprenorphine/naloxone users. Methods A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. Results Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a “bad-tasting” medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely “substance-free.” The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. Conclusions/Importance The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat.

Methadone and Suboxone® mentions on Twitter: Thematic and Sentiment Analysis

“…The authors categorized the discussion into themes that facilitated self-management with buprenorphine/naloxone. Although the study excluded methadone, the themes discovered by the authors were similar to those found in our current study, including the need for a ready supply of the medication from a variety of sources, distrust of buprenorphine prescribers and the pharmaceutical companies, and a desire to become completely "substance free" [17].…”

Long-Term Condition Self-Management Support in Online Communities: A Meta-Synthesis of Qualitative Papers

“…The long-term conditions examined in relation to online communities were diverse and clearly projected different illness experiences. They included heavily stigmatized conditions such as alcohol and substance use disorders [ 17 , 26 ] and human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) [ 27 , 36 ]; medically contested conditions, such as fibromyalgia [ 25 , 35 , 39 , 40 ]; and extremely physically disabling conditions, such as Parkinson disease [ 24 ], arthritis [ 29 , 39 , 40 ], chronic obstructive pulmonary disease (COPD) [ 41 ], cystic fibrosis [ 31 ], and motor neuron disease [ 30 , 32 ].…”

“…Members were frequently drawn to online groups through an unmet offline need for condition-specific information that was easy to understand [ 40 ], could be customized to their specific needs [ 26 , 28 , 40 , 42 ], was based on patient experience [ 30 , 36 , 43 ], and was freely available at their convenience [ 36 ]. The need for accessible, accurate, and up-to-date information was often directed by inadequate access to information offline, whereby community members felt let down by information providers in their offline worlds [ 29 , 36 ].…”

“…The sharing of experiential information in online communities is an important feature in shaping the experience of those living with a long-term condition because the information shared in these communities frequently favored patient-centered goals as opposed to HCP-centered metrics [ 28 , 29 , 31 ]. This information was easier for members to configure to their specific needs and was less rigid than the information and self-management strategies provided offline [ 26 , 28 , 29 , 31 , 42 ].…”

Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts

“…A search on self-management support for substance use disorder on PubMed yielded few relevant results at the time of writing (November 2020). Brown and Altice [ 31 ] studied themes related to self-management of MAT medications and found that online participants discussed personal experience and strategies of using unprescribed medication, distrust with health care providers, and desire to recover. Schaub et al [ 32 ] demonstrated the effectiveness of a web-based self-help intervention for participants with problematic cannabis use if it can be supplemented by brief chat counseling.…”