1
|
Daniulaityte R, Nahhas RW, Silverstein S, Martins S, Carlson RG. Trajectories of non-prescribed buprenorphine and other opioid use: A multi-trajectory latent class growth analysis. J Subst Use Addict Treat 2023; 147:208973. [PMID: 36804351 PMCID: PMC10044504 DOI: 10.1016/j.josat.2023.208973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/26/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION With the increasing use of non-prescribed buprenorphine (NPB), we need more data to identify the longitudinal patterns of NPB use. The goal of this natural history study is to characterize heterogeneity in trajectories of NPB, other opioid use, and participation in medication for opioid disorder (MOUD) treatment among a community-recruited sample of individuals with current opioid use disorder (OUD). METHODS The study recruited a community-based sample of 357 individuals with OUD who used NPB in the past 6 months in Ohio, United States, for baseline and follow-up assessments (every 6 months for 2 years) of drug use, treatment participation, and other health and psychosocial characteristics. The study used multiple imputation to handle missing data. We used a multi-trajectory latent class growth analysis (MT-LCGA) to find salient groupings of participants based on the trajectories of NPB, other opioid use, and treatment participation. RESULTS Over time, NPB use frequency declined from a mean of 14.6 % of days at baseline to 3.6 % of days at 24-month follow-up along with declines in heroin/fentanyl (56.4 % to 23.6 % of days) and non-prescribed pharmaceutical opioid (NPPO) use (11.6 % to 1.5 % of days). Participation in MOUD treatment increased from a mean of 17.0 % of days at baseline to 52.4 % of days at 24 months. MT-LCGA identified a 6-class model. All six classes showed declines in NPB use. Class 1 (28 %) was characterized by high and increasing MOUD treatment utilization. Class 2 (21 %) showed sustained high levels of heroin/fentanyl use and had the lowest levels of NPB use (2.2 % of days) at baseline. Class 3 (3 %) was characterized as the primary NPPO use group. Class 4 (5 %) transitioned from high levels of NPB use to increased MOUD treatment utilization. It had the highest levels of NPB use at baseline (average of 80.7 % of days) that decreased to an average of 12.9 % of days at 24 months. Class 5 (16 %) showed transition from high levels of heroin/fentanyl use to increased MOUD treatment utilization. Class 6 (27 %) showed decreased heroin/fentanyl use over time and low MOUD treatment utilization. Classes showed varying levels of improvement in psychosocial functioning, polydrug use, and overdose risks. CONCLUSION Overall, our findings suggest that NPB use was generally self-limiting with individuals reducing their use over time as some engage in greater utilization of MOUD treatment. A need exists for continuing improvements in MOUD treatment access and retention.
Collapse
Affiliation(s)
- Raminta Daniulaityte
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States of America.
| | - Ramzi W Nahhas
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America; Department of Psychiatry, Boonshoft School of Medicine, Wright State University, United States of America
| | - Sydney Silverstein
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America
| | - Silvia Martins
- Department of Epidemiology Columbia University Mailman School of Public Health, United States of America
| | - Robert G Carlson
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States of America
| |
Collapse
|
2
|
Williams AR, Mauro CM, Feng T, Wilson A, Cruz A, Olfson M, Crystal S, Samples H, Chiodo L. Non-prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder. J Subst Abuse Treat 2022; 139:108770. [PMID: 35337715 PMCID: PMC9187606 DOI: 10.1016/j.jsat.2022.108770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/01/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non-prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. METHODS The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015-2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use. RESULTS Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, p < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p = 0.89). CONCLUSION NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
Collapse
Affiliation(s)
- Arthur Robin Williams
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America.
| | - Christine M Mauro
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, United States of America
| | - Tianshu Feng
- Research Foundation for Mental Hygiene, 1051 Riverside Dr., New York, NY 10032, United States of America
| | - Amanda Wilson
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America
| | - Angelo Cruz
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America
| | - Hillary Samples
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America
| | - Lisa Chiodo
- Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America; University of Massachusetts Amherst, School of Nursing, 651 N Pleasant St, Amherst, MA 01003, United States of America
| |
Collapse
|
3
|
McLean K, Kavanaugh PR. "I'm Not a Good Drug Dealer": Styles of Buprenorphine Diversion in a Multisite Qualitative Study. Subst Use Misuse 2022; 57:452-460. [PMID: 35067160 DOI: 10.1080/10826084.2021.2019775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Against the backdrop of the U.S. opioid epidemic, there has been a concerted movement to improve access to buprenorphine maintenance therapy (BMT). In Pennsylvania, where overdose mortality increased 65% between 2015 and 2017, over $75 million has been appropriated toward BMT since 2016. Concurrently, efforts to increase BMT availability while lowering barriers to entry have given way to fears of increased diversion and illegitimate patients. Little is known about the circumstances and motivations that surround buprenorphine diversion, particularly within the context of treatment expansion. METHOD Drawing on 27 in-depth interviews with individuals who reported sharing or selling buprenorphine in the past year, in this study we consider the relationship between treatment access, treatment experiences, and individuals' decision to divert buprenorphine, while further comparing motivations for buprenorphine diversion across two Pennsylvania counties with disparate levels of BMT availability. RESULTS We identify four styles of buprenorphine diversion ("ad hoc sellers," "concerned suppliers," "social sharers," "professional dealers"), with different levels of representation by county. Overall, our analysis found the explicit economic exploitation of BMT was rare, while a plurality of participants reported selling unwanted or unneeded buprenorphine only when presented with an opportunity. CONCLUSIONS Across our typology, market demand in the form of unmet need for buprenorphine was the major driver of diversion, suggesting that "supply-side interventions" intended to again limit access to BMT may be counterproductive.
Collapse
Affiliation(s)
- Katherine McLean
- Administration of Justice, Penn State Greater Allegheny, McKeesport, Pennsylvania, USA
| | - Philip R Kavanaugh
- School of Public Affairs, Penn State Harrisburg, Middletown, Pennsylvania, USA
| |
Collapse
|