Gilbert Michael K, Daughton Ashlynn R, Chilcoat Howard D, Laffont Celine M, Strafford Stephanie, DeVeaugh-Geiss Angela M
Booz Allen Hamilton, McLean, VA, United States.
Indivior Inc, North Chesterfield, VA, United States.
J Med Internet Res. 2025 Apr 25;27:e71245. doi: 10.2196/71245.
Discontinuation of buprenorphine as a medication for opioid use disorder (MOUD) necessitates careful tapering to reduce opioid withdrawal and relapse. With a half-life of 43-60 days, buprenorphine extended-release formulation (BUP-XR) may provide gradual taper, facilitating successful treatment discontinuation.
This study sought to understand experiences with stopping BUP-XR as described on social media.
Reddit records (March 2018 to August 2022) were evaluated for the presence of referents to BUP-XR using parallel criteria based on predefined keywords and subreddit context. The keyword-based search identified records mentioning "Sublocade" (or similar search strings) regardless of subreddit. The subreddit context-based criteria identified records that were created within the r/Sublocade subreddit. Records that included reference to BUP-XR were further evaluated for mentions of treatment cessation using predefined keywords. A 50% randomized sample was then selected for qualitative analysis by a single experienced subject matter expert. Records were manually coded to validate references to BUP-XR and MOUD cessation and were evaluated for additional predefined constructs related to opioid craving and withdrawal, BUP-XR and other MOUD treatment details, and other nonmedical opioid use. Emergent constructs related to cessation-related knowledge, attitudes, behaviors, and experiences were also identified as part of the data coding and annotation process.
Of 6082 total, 3041 records were coded and analyzed; most (n=2692, 97.4%) referenced BUP-XR, of which, 43.8% (n=1179) referenced cessation of BUP-XR as MOUD. Many individuals shared information about prior use of MOUD, primarily transmucosal buprenorphine (185 records/63 authors), including the use of BUP-XR to taper off buprenorphine. Individuals provided details of their BUP-XR treatment experiences before and following cessation. Only 102 (8.7%) records mentioned opioid withdrawal; 1 record mentioned craving. Withdrawal experiences with BUP-XR were generally described as less intense than other drugs, although at least mild withdrawal was seen as an inevitable part of cessation. Thematic analysis revealed discussions of polypharmacy with transmucosal buprenorphine and the importance of personalized treatment and patient agency.
There was nuanced discussion of treatment cessation using BUP-XR on Reddit, with individuals describing detailed courses of treatment and treatment experiences. Few records mentioned opioid withdrawal, and when discussed, withdrawal experiences during cessation of BUP-XR were generally described as less intense than withdrawal experiences with other drugs. These results suggest that social media, such as Reddit, can be leveraged to explore perspectives on treatment and recovery among individuals with opioid use disorder. Overall, this study provides insights into real-world patient experiences with cessation of BUP-XR and is consistent with prior case series; however, more research is needed to understand the course of opioid use disorder following cessation of BUP-XR as well as other MOUD.
停用丁丙诺啡作为阿片类物质使用障碍（MOUD）的药物需要谨慎减量，以减少阿片类物质戒断反应和复发。丁丙诺啡缓释制剂（BUP-XR）的半衰期为43 - 60天，可能有助于逐渐减量，促进成功停药。
本研究旨在了解社交媒体上描述的停用BUP-XR的经历。
使用基于预定义关键词和子版块背景的并行标准，评估Reddit记录（2018年3月至2022年8月）中是否存在对BUP-XR的提及。基于关键词的搜索识别出提及“Sublocade”（或类似搜索字符串）的记录，无论其所在子版块。基于子版块背景的标准识别出在r/Sublocade子版块内创建的记录。对于包含对BUP-XR提及的记录，使用预定义关键词进一步评估是否提及治疗停药。然后由一位经验丰富的主题专家选择50%的随机样本进行定性分析。记录进行人工编码以验证对BUP-XR和MOUD停药的提及，并评估与阿片类物质渴望和戒断、BUP-XR及其他MOUD治疗细节以及其他非医疗性阿片类物质使用相关的其他预定义结构。与停药相关的知识、态度、行为和经历等新出现的结构也被识别为数据编码和注释过程的一部分。
在总共6082条记录中，3041条记录进行了编码和分析；大多数（n = 2692，97.4%）提及了BUP-XR，其中43.8%（n = 1179）提及停用BUP-XR作为MOUD。许多人分享了关于先前使用MOUD的信息，主要是经黏膜丁丙诺啡（185条记录/63位作者），包括使用BUP-XR逐渐停用丁丙诺啡。个人提供了他们在停药前后BUP-XR治疗经历的细节。只有102条（8.7%）记录提到了阿片类物质戒断；1条记录提到了渴望。BUP-XR的戒断经历通常被描述为比其他药物的戒断反应轻，尽管至少轻度戒断被视为停药不可避免的一部分。主题分析揭示了关于经黏膜丁丙诺啡联合用药以及个性化治疗和患者自主性的重要性的讨论。
在Reddit上有关于使用BUP-XR停药的细致讨论，个人描述了详细的治疗过程和治疗经历。很少有记录提到阿片类物质戒断，当提到时，BUP-XR停药期间的戒断经历通常被描述为比其他药物的戒断反应轻。这些结果表明，像Reddit这样的社交媒体可用于探索阿片类物质使用障碍患者对治疗和康复的看法。总体而言，本研究提供了关于现实世界中患者停用BUP-XR的经历的见解，并且与先前的病例系列一致；然而，需要更多研究来了解停用BUP-XR以及其他MOUD后阿片类物质使用障碍的病程。
