Institute of Psychiatry, National Addiction Centre, King's College London, London, UK.
Centre for Social Research in Health, University of New South Wales, Kensington, Australia.
Subst Use Misuse. 2023;58(13):1696-1706. doi: 10.1080/10826084.2023.2244064. Epub 2023 Aug 12.
Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Patients' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.
在治疗阿片类药物使用障碍 (OUD) 期间，非处方物质使用 (NPSU) 是一种公认的现象。使用非处方物质与停止治疗有关，并且在治疗开始后的早期几周内可能会出现治疗中断和退出，而在治疗开始前就已经出现了益处。治疗方面的最新进展包括长效、缓慢释放的丁丙诺啡注射剂。本文重点介绍了丁丙诺啡储存库治疗的第一个月期间的 NPSU，讨论了其发生的频率、使用的物质以及使用的原因。作为一项纵向定性研究的一部分，对 26 名开始使用丁丙诺啡储存库的患者进行了 70 次半结构式访谈（在三个时间点进行）。分析优先考虑内容和框架分析。26 名参与者中有 17 名在治疗的第一个月的不同时间报告了 NPSU。NPSU 通常涉及海洛因、可卡因和一些苯二氮䓬类药物和/或大麻的使用。参与者使用海洛因的原因与他们对阿片类药物戒断症状的主观描述、疼痛的管理以及试验（测试丁丙诺啡的阻断作用）有关。海洛因使用的频率通常是间歇性的，而不是持续性的。参与者将可卡因的使用与兴奋剂的渴望和社会联系联系起来，并认为他们使用这种物质难以管理。患者对 OUD 治疗的初始参与在定性研究中很少被研究。本研究强调了在接受新形式治疗的患者中，NPSU 仍然是一个挑战。因此，关于治疗目标和 NPSU 的共同决策（提供者和患者之间）应该是储存丁丙诺啡治疗计划的核心。
