McDonald Madelyn J, DeVeaugh-Geiss Angela M, Chilcoat Howard D, Havens Jennifer R
From the Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY (MJMD, JRH); Indivior, PLC, North Chesterfield, VA (AMDV, HDC); and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (HDC).
J Addict Med. 2023;17(1):95-100. doi: 10.1097/ADM.0000000000001050. Epub 2022 Aug 30.
Buprenorphine (Suboxone) is an effective treatment for opioid use disorder (OUD). However, there have been widespread reports of diversion and misuse. This study examined motivations for nonprescribed buprenorphine use among rural residents.
Eligible participants (N = 200) were at least 18 years old, had used any illegal or prescription drugs to get high, and had ever used nonprescribed buprenorphine. A questionnaire administered by a trained interviewer assessed demographic characteristics, substance use, and motivations for use.
Primary motivations for first nonprescribed buprenorphine use included avoiding withdrawal and getting high, while at most recent nonprescribed use, motivations shifted toward maintaining abstinence from other drugs. In adjusted logistic regression analyses, past month use of stimulants decreased odds of nonprescribed buprenorphine use for the purposes of self-treatment by 68% (adjusted odds ratio, 0.26; 95% confidence interval, 0.11-0.61), whereas history of treatment for OUD more than doubled odds of use for self-treatment (adjusted odds ratio, 2.71; 95% confidence interval, 1.11-6.63).
Results indicate that many individuals used buprenorphine without a prescription, motivated largely by behaviors consistent with self-treatment, and diversion of buprenorphine may be driven by these motivations more than desire to get high. While many participants attempted to access treatment, many were still using nonprescribed buprenorphine for self-treatment, and many were dissatisfied with care they had received as part of a treatment program. Thus, increasing quantity of providers may not be adequate to address the opioid epidemic, but particular attention should be paid to providing care targeted to the needs of those with OUD in rural areas.
丁丙诺啡（舒泊西汀）是治疗阿片类物质使用障碍（OUD）的有效药物。然而，关于其被转移和滥用的报道广泛存在。本研究调查了农村居民非处方使用丁丙诺啡的动机。
符合条件的参与者（N = 200）年龄至少18岁，曾使用任何非法或处方药来寻求快感，且曾非处方使用过丁丙诺啡。由经过培训的访谈员进行问卷调查，评估人口统计学特征、物质使用情况及使用动机。
首次非处方使用丁丙诺啡的主要动机包括避免戒断反应和寻求快感，而在最近一次非处方使用时，动机转向维持对其他药物的戒断。在调整后的逻辑回归分析中，过去一个月使用兴奋剂使为自我治疗而非处方使用丁丙诺啡的几率降低了68%（调整后的优势比，0.26；95%置信区间，0.11 - 0.61），而有OUD治疗史使自我治疗使用丁丙诺啡的几率增加了一倍多（调整后的优势比，2.71；95%置信区间，1.11 - 6.63）。
结果表明，许多人在没有处方的情况下使用丁丙诺啡，主要动机与自我治疗行为一致，丁丙诺啡的转移可能更多是由这些动机驱动，而非寻求快感的欲望。虽然许多参与者试图获得治疗，但仍有许多人在非处方使用丁丙诺啡进行自我治疗，且许多人对他们作为治疗项目一部分所接受的护理不满意。因此，增加提供者数量可能不足以应对阿片类药物流行问题，但应特别关注为农村地区有OUD者的需求提供针对性护理。
