title: Self-treatment: illicit buprenorphine use by opioid-dependent treatment seekers.
abstract: Outpatient-based opioid treatment (OBOT) with buprenorphine is an important treatment for people with opioid dependence. No quantitative empirical research has examined rationales for use of illicit buprenorphine by U.S. opioid-dependent treatment seekers. The current study sequentially screened OBOT admissions (n = 129) during a 6-month period in 2009. This study had two stages: (a) a cross-sectional epidemiological analysis of new intakes and existing patients already receiving a legal OBOT prescription (n = 78) and (b) a prospective longitudinal cohort design that followed 76% of the initial participants for 3 months of treatment (n = 42). The primary aims were to establish 2009 prevalence rates for illicit buprenorphine use among people seeking OBOT treatment, to use quantitative methods to investigate reasons for this illicit use, and to examine the effect of OBOT treatment on illicit buprenorphine use behavior. These data demonstrate a decrease in illicit use when opioid-dependent treatment seekers gain access to legal prescriptions. These data also suggest that the use of illicit buprenorphine rarely represents an attempt to attain euphoria. Rather, illicit use is associated with attempted self-treatment of symptoms of opioid dependence, pain, and depression.
authors.affiliation: Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, United States. zschuman@partners.org
authors.forename: Zev
authors.initials: Z
authors.lastname: Schuman-Olivier
authors.forename: Mark
authors.initials: M
authors.lastname: Albanese
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Nelson
authors.forename: Lolita
authors.initials: L
authors.lastname: Roland
authors.forename: Francyne
authors.initials: F
authors.lastname: Puopolo
authors.forename: Lauren
authors.initials: L
authors.lastname: Klinker
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Shaffer
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D010146:Pain / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012651:Self Medication / Q000523:psychology*; D014481:United States / Q000453:epidemiology
chemical_list: D009294:Narcotics; D002047:Buprenorphine