Intravenous misuse of buprenorphine: characteristics and extent among patients undergoing drug maintenance therapy.
Sublingual buprenorphine [Subutex(R)] is used to treat opioid dependence. However, illicit intravenous (IV) injection of buprenorphine is a widespread problem. This survey investigated the IV misuse of buprenorphine among patients receiving drug replacement therapy at the Drug Addiction Centre in Udine, Italy. All patients who were receiving treatment with buprenorphine or methadone at the Drug Addiction Centre were invited to fill in a voluntary and anonymous questionnaire consisting of five questions. The questions asked if the patient had ever misused buprenorphine intravenously, when the misuse had occurred, the patient's reasons for misusing buprenorphine, the patient's perception of their experience, and the patient's perception of how widespread IV misuse of buprenorphine is. 307 patients completed the questionnaire, 93 and 214 of whom, respectively, were receiving buprenorphine and methadone. In total, 23.12% of patients admitted an IV misuse of buprenorphine, with a significantly greater prevalence among patients currently receiving buprenorphine (35.48%) than those receiving methadone (17.75%; p < 0.001). Younger patients were also more likely to have misused buprenorphine, and tended to have done so before coming to the Drug Addiction Centre. The most frequent motivation for IV misuse was treatment of heroin addiction or withdrawal symptoms (50.71%), while only 12.67% of patients reported that their motivation was to experience pleasure or euphoria. The majority of patients who had misused buprenorphine intravenously (53.52%) had a negative experience, and methadone recipients were significantly more likely to find the experience negative than buprenorphine recipients (68.42% vs 36.36%; p = 0.007). Almost half of the patients (45.93%) thought that at least 50% of patients had taken buprenorphine by IV injection. The results of our study confirm the widespread IV misuse of buprenorphine. Misuse was most common among patients currently receiving buprenorphine treatment and younger patients. For the majority of patients, the reason for IV misuse was to treat their dependence. We believe that the prevalence of buprenorphine misuse could be reduced by adopting appropriate clinical practices and treating patients with the buprenorphine/naloxone combination rather than buprenorphine alone.
Moratti
Enrico
E
Drug Addiction Centre, Azienda per i Servizi Sanitari n. 4 - Udine, Italy. enrico.moratti@ass4.sanita.fvg.it
Kashanpour
Hamid
H
Lombardelli
Tiziana
T
Maisto
Maria
M
D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016739:Behavior, Addictive; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007275:Injections, Intravenous; D007558:Italy / Q000453:epidemiology; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009042:Motivation; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010465:Perception; D015995:Prevalence; D012307:Risk Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
Subst Use Misuse. 2003 Feb-May;38(3-6):429-42
12747392
J Pain Palliat Care Pharmacother. 2009;23(2):153-5
19492216
Drug Alcohol Depend. 2003 May 21;70(2 Suppl):S29-37
12738348
N Engl J Med. 2005 Oct 27;353(17):1863-5
16251550
Drug Alcohol Depend. 1998 Mar 1;50(1):1-8
9589267
Addiction. 2003 Nov;98(11):1585-97
14616185
Med J Aust. 2009 Aug 3;191(3):161-5
19645647
Addiction. 2001 Oct;96(10):1433-41
11571062
J Pharmacol Exp Ther. 1976 Jun;197(3):517-32
945347
Drug Alcohol Depend. 2007 Apr 17;88(1):75-8
17055191
Drug Alcohol Depend. 2008 Sep 1;97(1-2):105-13
18479840
N Engl J Med. 2000 Nov 2;343(18):1290-7
11058673
Psychopharmacology (Berl). 2005 Oct;181(4):664-75
16025322
Br J Addict. 1989 Apr;84(4):439-41
2566343
Drug Alcohol Depend. 2003 Mar 1;69(2):175-81
12609698
Psychopharmacology (Berl). 1999 Jan;141(1):37-46
9952063
J Clin Psychopharmacol. 1996 Feb;16(1):58-67
8834420
Addiction. 2001 Feb;96(2):267-72
11182872
Drug Alcohol Depend. 1993 Jun;33(1):81-6
8370341
Drug Alcohol Rev. 2008 Mar;27(2):197-9
18264882
Am J Addict. 2004;13 Suppl 1:S17-28
15204673
Am J Med. 1998 Aug;105(2):100-5
9727815
J Clin Psychopharmacol. 2004 Oct;24(5):479-87
15349002
Health Bull (Edinb). 1993 Nov;51(6):418-29
8307755
Encephale. 2002 Sep-Oct;28(5 Pt 1):397-402
12386540
Addiction. 2005 Feb;100(2):197-205
15679749
Eur Addict Res. 2007;13(4):207-15
17851242