title: Prevalence and correlates of street-obtained buprenorphine use among current and former injectors in Baltimore, Maryland.
abstract: OBJECTIVE
  There are few systematic assessments of street-obtained buprenorphine use from community-based samples in the United States. The objective of this study was to characterize the prevalence, correlates, and reasons for street-obtained buprenorphine use among current and former injection drug users (IDUs) in Baltimore, Maryland.
  
  
  METHODS
  In 2008, participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based cohort of IDUs, were administered a survey on buprenorphine. Street-obtained buprenorphine represented self-reported use of buprenorphine obtained from the street or a friend in the prior three months.
  
  
  RESULTS
  Six hundred and two respondents were predominantly male (65%), African-American (91%), and 30% were HIV-positive. Overall, nine percent reported recent street-obtained buprenorphine use, and only 2% reported using to get high. Among active opiate users, 23% reported recent use of street-obtained buprenorphine. Use of buprenorphine prescribed by a physician, injection and non-injection drug use, use of street-obtained methadone and prescription opiates, homelessness, and opioid withdrawal symptoms were positively associated, while methadone treatment, health insurance, outpatient care, and HIV-infection were negatively associated with recent street-obtained buprenorphine use in univariate analysis. After adjustment, active injection and heroin use were positively associated with street-obtained buprenorphine use. Ninety-one percent reported using street-obtained buprenorphine to manage withdrawal symptoms.
  
  
  CONCLUSIONS
  While 9% reported recent street-obtained buprenorphine use, only a small minority reported using buprenorphine to get high, with the majority reporting use to manage withdrawal symptoms. There is limited evidence of diversion of buprenorphine in this sample and efforts to expand buprenorphine treatment should continue with further monitoring.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615N. Wolfe Street, Baltimore, MD 21205 USA.
authors.forename: Becky L
authors.initials: BL
authors.lastname: Genberg
authors.forename: Mirinda
authors.initials: M
authors.lastname: Gillespie
authors.forename: Charles R
authors.initials: CR
authors.lastname: Schuster
authors.forename: Chris-Ellyn
authors.initials: CE
authors.lastname: Johanson
authors.forename: Jacquie
authors.initials: J
authors.lastname: Astemborski
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
mesh_terms: D015142:Baltimore / Q000453:epidemiology; D002047:Buprenorphine / Q000600:supply & distribution*; D004812:Epidemiologic Methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D013287:Illicit Drugs / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000600:supply & distribution*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000534:rehabilitation
chemical_list: D013287:Illicit Drugs; D009294:Narcotics; D002047:Buprenorphine
keywords: Buprenorphine; Diversion; Drug treatment; Injection drug use
references.citation: Am J Addict. 2008 Mar-Apr;17(2):116-20
references.pmid: 18393054
references.citation: Drug Alcohol Depend. 2012 Jan 1;120(1-3):190-5
references.pmid: 21862241
references.citation: Addiction. 1998 Apr;93(4):475-86
references.pmid: 9684386
references.citation: Addiction. 1998 Aug;93(8):1191-7
references.pmid: 9813900
references.citation: Am J Epidemiol. 2011 Apr 1;173(7):829-36
references.pmid: 21320867
references.citation: Drug Alcohol Depend. 2003 Mar 1;69(2):175-81
references.pmid: 12609698
references.citation: J Urban Health. 2004 Sep;81(3):377-400
references.pmid: 15273263
references.citation: J Subst Abuse Treat. 2008 Jul;35(1):87-92
references.pmid: 17933486
references.citation: JAMA. 1992 May 27;267(20):2750-5
references.pmid: 1578593
references.citation: NIDA Res Monogr. 1991;109:75-100
references.pmid: 1661376
references.citation: Addiction. 2007 May;102(5):771-7
references.pmid: 17506154
references.citation: Pain Med. 2010 Jul;11(7):1078-91
references.pmid: 20545875
references.citation: Drug Alcohol Depend. 1988 May;21(2):81-97
references.pmid: 3416736
references.citation: Drug Alcohol Depend. 2006 Jun 28;83(2):147-56
references.pmid: 16364568
references.citation: N Engl J Med. 2005 Oct 27;353(17):1863-5
references.pmid: 16251550
references.citation: Addiction. 2003 Apr;98(4):441-52
references.pmid: 12653814
references.citation: Addiction. 1993 Apr;88(4):517-26
references.pmid: 8485429
references.citation: J Urban Health. 2008 May;85(3):323-51
references.pmid: 18344002
references.citation: N Engl J Med. 2003 Sep 4;349(10):949-58
references.pmid: 12954743
references.citation: Am J Addict. 2009 Sep-Oct;18(5):346-55
references.pmid: 19874152
references.citation: Drug Alcohol Depend. 2008 Jan 1;92(1-3):267-76
references.pmid: 17913395
references.citation: J Addict Med. 2011 Sep;5(3):175-80
references.pmid: 21844833
references.citation: Drug Alcohol Depend. 2009 Sep 1;104(1-2):73-7
references.pmid: 19443138
references.citation: Drug Alcohol Depend. 1985 Feb;14(3-4):283-303
references.pmid: 3888577
references.citation: Drug Alcohol Depend. 2003 May 21;70(2 Suppl):S13-27
references.pmid: 12738347
references.citation: Am J Addict. 2004;13 Suppl 1:S17-28
references.pmid: 15204673
references.citation: Addiction. 2004 Aug;99(8):978-88
references.pmid: 15265095
references.citation: N Engl J Med. 2000 Nov 2;343(18):1290-7
references.pmid: 11058673
references.citation: J Addict Dis. 2009 Jul;28(3):226-31
references.pmid: 20155591
references.citation: Addiction. 2010 Sep;105(9):1531-7
references.pmid: 20626373
references.citation: Am J Epidemiol. 2003 Oct 1;158(7):695-704
references.pmid: 14507606
references.citation: J Pharmacol Exp Ther. 1995 Jul;274(1):361-72
references.pmid: 7542336
references.citation: Clin Pharmacol Ther. 1994 May;55(5):569-80
references.pmid: 8181201
references.citation: J Addict Dis. 2007;26(3):107-11
references.pmid: 18018814
references.citation: J Subst Abuse Treat. 2010 Jul;39(1):41-50
references.pmid: 20434868