Division44 of General Internal Medicine, Montefiore Medical Center, Bronx, NY, USA.
New York Harm Reduction Educators, New York, NY, USA.
Subst Use Misuse. 2021;56(8):1137-1143. doi: 10.1080/10826084.2021.1908360. Epub 2021 May 3.
People may overcome barriers to professional buprenorphine treatment by using non-prescribed buprenorphine (NPB) to manage opioid use disorder (OUD). Little is known about how people perceive NPB differently than formal treatment. This qualitative study investigated how and why people use NPB as an alternative to formal treatment.
In-depth, semi-structured interviews were conducted with participants of harm reduction agencies (=22) who had used buprenorphine. Investigators independently coded transcribed interviews, generating themes through iterative reading and analysis of transcripts.
Three main factors drove decisions about prescribed and non-prescribed buprenorphine use: 1) autonomy; 2) treatment goals; and 3) negative early experiences with NPB. An overarching theme from our analysis was that participants valued autonomy in seeking to control their substance use. NPB was a valuable tool toward this goal and professional OUD treatment could impede autonomy. Participants mostly used NPB to "self-manage" OUD symptoms. Many participants had concerns about long-term buprenorphine treatment and instead used NPB over short periods of time. Several participants also reported negative experiences with NPB, including symptoms of withdrawal, which then deterred them from seeking out professional treatment.
These results support prior studies showing that people use NPB to self-manage withdrawal symptoms and to reduce use of illicit opioids. Despite these benefits, participants focused on short-term goals and negative consequences were common. Increasing buprenorphine treatment engagement may require attention to patients' sense of autonomy, and also assurance that long-term treatment is safe, effective, and reliably accessible.
人们可能会通过使用非处方丁丙诺啡（NPB）来管理阿片类药物使用障碍（OUD），从而克服专业丁丙诺啡治疗的障碍。人们对 NPB 与正规治疗的看法不同，这方面知之甚少。这项定性研究调查了人们如何以及为何将 NPB 用作正规治疗的替代方法。
对参加减少伤害机构的参与者（=22）进行了深入的半结构化访谈，这些参与者曾使用过丁丙诺啡。调查人员独立对转录的访谈进行编码，通过对转录本的反复阅读和分析生成主题。
决定使用处方和非处方丁丙诺啡的三个主要因素是：1）自主性；2）治疗目标；3）对 NPB 的早期负面体验。我们分析的一个首要主题是，参与者重视寻求控制自己的药物使用的自主权。NPB 是实现这一目标的宝贵工具，而专业的 OUD 治疗可能会妨碍自主性。参与者主要使用 NPB 来“自我管理”OUD 症状。许多参与者对长期丁丙诺啡治疗表示担忧，因此选择短期使用 NPB。一些参与者还报告了对 NPB 的负面体验，包括戒断症状，这使他们不愿寻求专业治疗。
这些结果支持了先前的研究，表明人们使用 NPB 来自我管理戒断症状并减少非法阿片类药物的使用。尽管有这些好处，但参与者关注短期目标，负面后果很常见。增加丁丙诺啡治疗的参与度可能需要关注患者的自主权意识，同时确保长期治疗是安全、有效且可靠的。
