Alternative use of buprenorphine among people who use opioids in three U.S. Cities

Abstract

Background: Buprenorphine is an effective treatment for opioid use disorder, yet some persons are concerned with its “alternative use” (i.e., any use unintended by the prescriber). There is limited evidence on the factors associated with alternative use of buprenorphine (AUB); in this study, we examined correlates of recent (past 6 months) AUB. Methods: Multivariable logistic regression was used to analyze survey data from a multi-site, cross-sectional study of people who use drugs (PWUD) (N = 334) in Baltimore, Maryland; Boston, Massachusetts; and Providence, Rhode Island. Results: One-fifth (20%) of the sample reported recent AUB. In adjusted analyses, significant negative correlates of AUB were female gender (adjusted odds ratio [aOR] 0.48, 95% confidence intervals [CI] 0.24–0.95), recent emergency room visit (aOR 0.45, 95% CI 0.23–0.89), and recent injection drug use (aOR 0.41, 95% CI 0.19–0.88). Significant positive correlates were alternative use of other prescription opioids (aOR 8.32, 95% CI 4.22–16.38), three or more overdoses in the past year (aOR 3.74, 95% CI 1.53–9.17), recent buprenorphine use as prescribed (aOR 2.50, 95% CI 1.12–5.55), and recent residential rehabilitation treatment (aOR 3.71, 95% CI 1.50–9.16). Conclusions: Structural and behavioral correlates of AUB may help identify PWUD at high risk of overdose with unmet treatment needs.

Keywords:

• Buprenorphine
• opioid agonist therapy
• medications for opioid use disorder
• alternative use

Acknowledgements

We thank the participants of this study for their time and insights, without which this study would not be possible. We would like to recognize the FORECAST study team and collaborators for their research efforts.

Disclosure statement

Dr. Sherman is an expert witness for plaintiffs in opioid litigation. Remaining authors report no conflicts of interest nor financial disclosures.

Author contributions

SGS and TCG conceived of parent study. JNP provided overall study coordination across sites. KBM served as data manager for parent study. PG conducted analysis and produced this manuscript with contributions from SR. All authors provided critical feedback and contributed important intellectual content.

Additional information

Funding

This work was supported by the Bloomberg American Health Initiative (BAHI). Dr. Rouhani is supported on a training grant by the National Institute for Drug Abuse/National Institute of Health [T32DA007292]. Dr. Allen is supported by NIDA [K01 DA046234]. Dr. Green is supported through the National Institute of General Medical Sciences COBRE on Opioids and Overdose [NIGMS P20GM125507] and the National Institute for Drug Abuse [R01DA045745, R21/R33 DA045848]. Dr. Sherman is supported by the Johns Hopkins University Center for AIDS Research [1P30AI094189]. The funding sources were not involved in the preparation of this manuscript.