Non-prescribed Buprenorphine Use Among People With Opioid Use Disorder is Primarily Therapeutic and Reduces the Risk of Overdose

Buprenorphine is an effective treatment for opioid use disorder (OUD) and reduces the risk of overdose, but many people with OUD in the US do not have access to it and there are concerns about diversion. Previous studies have indicated that reasons for non-prescribed buprenorphine use (NPBU) among individuals with OUD are generally consistent with therapeutic goals. Researchers in Ohio recruited a cohort of 356 individuals with OUD and self-reported NPBU to investigate motivations for NPBU and the association between NPBU and self-reported overdose.

  • Based on qualitative interviews of 65 participants, a number of motivations for NPBU were identified:
    • Avoiding the demands of formal treatment (e.g., attending meetings).
    • “Geographic cure” (doing a self-taper in another locality).
    • As a path to formal treatment (avoiding the wait).
    • Desire for autonomy and self-determination (having ownership over the recovery process).
  • In a separate analysis of the entire cohort, 28% of participants reported experiencing an overdose in the past 6 months.
    • Higher mean percentage of days of NPBU in the past 6 months was associated with a decreased risk of overdose in both unadjusted (odds ratio [OR], 0.82) and adjusted analyses (adjusted OR [aOR], 0.81), with a linear trend of lower overdose risk with increasing NPBU.
    • Factors associated with an increased risk of overdose included prior overdose (aOR, 2.19) and injection drug use (aOR, 2.49).

Comments: These studies show that individuals with OUD are generally using non-prescribed buprenorphine for appropriate reasons and that diversion of buprenorphine has some benefits. This highlights the need for accessible, flexible, patient-centered treatment. Moreover, efforts to criminalize and clamp down on buprenorphine diversion are likely to do more harm than good.

Darius A. Rastegar, MD

References: Silverstein SM, Daniulaityte R, Miller SC, et al. On my own terms: motivations for self-treating opioid-use disorder with non-prescribed buprenorphine. Drug Alcohol Depend. 2020;210:107958.

Carlson RG, Daniulaityte R, Silverstein SM, et al. Unintentional drug overdose: is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose? Int J Drug Policy. 2020;79:102722.

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