Non-prescribed substance use during the first month of treatment by people receiving depot buprenorphine for opioid use disorder

Stephen Parkin; Joanne Neale; John Strang

doi:10.1080/10826084.2023.2244064

Non-prescribed substance use during the first month of treatment by people receiving depot buprenorphine for opioid use disorder

Stephen Parkin, Joanne Neale, John Strang

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants’ reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients’ initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.

Original language	English
Pages (from-to)	1696-1706
Number of pages	11
Journal	Substance Use and Misuse
Volume	58
Issue number	13
DOIs	https://doi.org/10.1080/10826084.2023.2244064
Publication status	Published - 12 Aug 2023

Keywords

Humans
Buprenorphine/adverse effects
Heroin
Opioid-Related Disorders/drug therapy
Analgesics, Opioid/therapeutic use
Opiate Substitution Treatment
Substance Withdrawal Syndrome
Cocaine/therapeutic use

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/10826084.2023.2244064

Cite this

@article{5593c26cbc2541d6839ab42cb7022649,

title = "Non-prescribed substance use during the first month of treatment by people receiving depot buprenorphine for opioid use disorder",

abstract = "Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants{\textquoteright} reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients{\textquoteright} initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.",

keywords = "Humans, Buprenorphine/adverse effects, Heroin, Opioid-Related Disorders/drug therapy, Analgesics, Opioid/therapeutic use, Opiate Substitution Treatment, Substance Withdrawal Syndrome, Cocaine/therapeutic use",

author = "Stephen Parkin and Joanne Neale and John Strang",

note = "Funding Information: In the last three years, S.P. has been part-funded by income from research grants obtained from MundiPharma Research Ltd and Camurus AB. J.N. has received, through her university, research funding from Mundipharma Research Ltd and Camurus AB and honoraria from Indivior and Camurus AB for unrelated webinar presentations. In the last three years, J.S. has secured, through his university, research funding from Mundipharma Research Ltd, Camurus AB, and Pneumowave (for further details, see www.kcl.ac.uk/people/john-strang ). Funding Information: support for the study was provided by Camurus AB, the company which developed Buvidal. The authors would like to thank all study participants for sharing their views and experiences during interviews, as well as staff at the six services for enabling access to their patients, Mr Paul Lennon for providing expert feedback to help shape the study design, and Mr James Gunn for transcription. Joanne Neale and Stephen Parkin are part-funded by, and John Strang is supported by, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London, UK. The views expressed are those of the authors and not necessarily those of Camurus (who provided funding support for the study), the NHS, the NIHR, or the Department of Health. Funding Information: The authors would like to thank all study participants for sharing their views and experiences during interviews, as well as staff at the six services for enabling access to their patients, Mr Paul Lennon for providing expert feedback to help shape the study design, and Mr James Gunn for transcription. Joanne Neale and Stephen Parkin are part-funded by, and John Strang is supported by, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London, UK. The views expressed are those of the authors and not necessarily those of Camurus (who provided funding support for the study), the NHS, the NIHR, or the Department of Health. Publisher Copyright: {\textcopyright} 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.",

year = "2023",

month = aug,

day = "12",

doi = "10.1080/10826084.2023.2244064",

language = "English",

volume = "58",

pages = "1696--1706",

journal = "Substance Use and Misuse",

issn = "1082-6084",

publisher = "Taylor and Francis",

number = "13",

}

TY - JOUR

T1 - Non-prescribed substance use during the first month of treatment by people receiving depot buprenorphine for opioid use disorder

AU - Parkin, Stephen

AU - Neale, Joanne

AU - Strang, John

N1 - Funding Information: In the last three years, S.P. has been part-funded by income from research grants obtained from MundiPharma Research Ltd and Camurus AB. J.N. has received, through her university, research funding from Mundipharma Research Ltd and Camurus AB and honoraria from Indivior and Camurus AB for unrelated webinar presentations. In the last three years, J.S. has secured, through his university, research funding from Mundipharma Research Ltd, Camurus AB, and Pneumowave (for further details, see www.kcl.ac.uk/people/john-strang ). Funding Information: support for the study was provided by Camurus AB, the company which developed Buvidal. The authors would like to thank all study participants for sharing their views and experiences during interviews, as well as staff at the six services for enabling access to their patients, Mr Paul Lennon for providing expert feedback to help shape the study design, and Mr James Gunn for transcription. Joanne Neale and Stephen Parkin are part-funded by, and John Strang is supported by, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London, UK. The views expressed are those of the authors and not necessarily those of Camurus (who provided funding support for the study), the NHS, the NIHR, or the Department of Health. Funding Information: The authors would like to thank all study participants for sharing their views and experiences during interviews, as well as staff at the six services for enabling access to their patients, Mr Paul Lennon for providing expert feedback to help shape the study design, and Mr James Gunn for transcription. Joanne Neale and Stephen Parkin are part-funded by, and John Strang is supported by, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London, UK. The views expressed are those of the authors and not necessarily those of Camurus (who provided funding support for the study), the NHS, the NIHR, or the Department of Health. Publisher Copyright: © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

PY - 2023/8/12

Y1 - 2023/8/12

N2 - Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants’ reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients’ initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.

AB - Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants’ reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients’ initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.

KW - Humans

KW - Buprenorphine/adverse effects

KW - Heroin

KW - Opioid-Related Disorders/drug therapy

KW - Analgesics, Opioid/therapeutic use

KW - Opiate Substitution Treatment

KW - Substance Withdrawal Syndrome

KW - Cocaine/therapeutic use

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U2 - 10.1080/10826084.2023.2244064

DO - 10.1080/10826084.2023.2244064

M3 - Article

C2 - 37571999

SN - 1082-6084

VL - 58

SP - 1696

EP - 1706

JO - Substance Use and Misuse

JF - Substance Use and Misuse

IS - 13

ER -

Non-prescribed substance use during the first month of treatment by people receiving depot buprenorphine for opioid use disorder

Abstract

Keywords

UN SDGs

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