Administration of Justice, Penn State Greater Allegheny, 4000 University Drive, McKeesport, PA, 15131, United States.
School of Public Affairs, Penn State Harrisburg, 777 W. Harrisburg Pike, Middletown, PA, 17057, United States.
Int J Drug Policy. 2019 Sep;71:118-124. doi: 10.1016/j.drugpo.2019.06.019. Epub 2019 Jul 20.
Buprenorphine maintenance therapy (BMT) has been widely recognized as one of the most effective treatments for opioid use disorders (OUD). In the midst of the U.S. opioid overdose crisis, local, state, and federal authorities have attempted to increase the availability of BMT, yet few individuals meeting the criteria for OUD utilize BMT. Moreover, recent research suggests that a significant proportion of individuals who use opioids seek out buprenorphine on the illicit market to self-govern and manage withdrawal sickness.
This paper presents data from a geographic sub-sample within a multi-site study of buprenorphine diversion in Pennsylvania. We endeavor to bolster a slim qualitative literature on the use of non-prescribed buprenorphine through in-depth interviews with 20 individuals who reported buying or receiving buprenorphine outside of medically-sanctioned contexts. Interviews characterized participants' reasons for both using non-prescribed buprenorphine and eschewing formal treatment, in a state (Pennsylvania) afflicted with high rates of heroin use and overdose deaths. Transcripts were initially coded for broad interview topics, while latent themes relating to buprenorphine diversion and extra-medical use also emerged.
Analyses revealed complex motivations underlying participants' extra-medical use of buprenorphine. Where some expressed a desire for treatment autonomy and treatment medications that could not be achieved or obtained within BMT, individuals also indicated a persistent lack of treatment availability and access due to diverse barriers.
This study shows how issues related to availability, accessibility, and acceptability many explain low rates of BMT utilization, even within a place and time defined by medication-assisted treatment expansion. Beyond offering broad rhetorical and financial support for MAT, our findings suggest that governmental actors should continue to pursue policies that expand the spatial distribution of BMT. It also underscores the need to look beyond current models of buprenorphine maintenance and to consider modes of buprenorphine delivery beyond long-term maintenance.
丁丙诺啡维持治疗（BMT）已被广泛认为是治疗阿片类药物使用障碍（OUD）最有效的方法之一。在美国阿片类药物过量危机期间，地方、州和联邦当局试图增加 BMT 的可及性，但符合 OUD 标准的人很少使用 BMT。此外，最近的研究表明，相当一部分使用阿片类药物的人在非法市场上寻求丁丙诺啡来自我管理和控制戒断症状。
本文介绍了宾夕法尼亚州多地点丁丙诺啡转移研究中地理子样本的数据。我们通过对 20 名在非医疗环境下报告购买或接受丁丙诺啡的个人进行深入访谈，努力支持关于非处方丁丙诺啡使用的少量定性文献。在一个受海洛因使用和过量死亡率高影响的州（宾夕法尼亚州），访谈描述了参与者使用非处方丁丙诺啡和避免正规治疗的原因。转录本最初按广泛的访谈主题进行编码，同时也出现了与丁丙诺啡转移和非医疗用途相关的潜在主题。
分析揭示了参与者非医疗使用丁丙诺啡的复杂动机。一些人表示希望获得治疗自主权和无法在 BMT 中获得或获得的治疗药物，而个人也表示由于各种障碍，持续存在治疗可及性和可及性不足的问题。
这项研究表明，可用性、可及性和可接受性相关问题可以解释 BMT 利用率低的原因，即使在一个以药物辅助治疗扩张为特征的地方和时间也是如此。除了为 MAT 提供广泛的修辞和财政支持外，我们的研究结果表明，政府行为者应继续推行扩大 BMT 空间分布的政策。它还强调需要超越当前的丁丙诺啡维持模式，并考虑超越长期维持的丁丙诺啡输送模式。
