Saturday, August 24, 2013

Street-Obtained Buprenorphine: Drug of Abuse, or Proof of Limited Access?

In a recent article from the journal Addictive Behaviors, researchers discovered that buprenorphine was rarely, if ever, used by IV drug users to get high. In fact, the vast majority of people who reported acquiring the medication from an illicit source did so with the expressed purpose of avoiding withdrawal symptoms. This seems to contradict the common misconception that heroin users "get high" on Suboxone, therefore we should promote abstinence-based treatment. To the contrary, studies like this one could be interpreted as evidence there is not enough access to these medications - if there were, people wouldn't be forced to seek the drugs from street dealers or friends.
Interested to hear your take on the subject.

Below is a table from study. You can read the abstract here: http://www.sciencedirect.com/science/article/pii/S0306460313002232

Table 2. Knowledge and Use of Buprenorphine among 602 Injection Drug Users in Baltimore, Maryland.
Buprenorphine
N (%)
Suboxone
N (%)
Subutex
N (%)
Buprenex
N (%)
Any
N (%)
Ever heard of drug537 (89)355 (59)52 (9)68 (11)541 (90)
Seen sold on street430 (71)232 (39)13 (2)18 (3)446 (74)
Ever used246 (41)112 (19)12 (2)9 (1)273 (45)
Usual sourcea
Doctor
Friend
Street
124 (50)
32 (13)
55 (22)
71 (63)
8 (7)
18 (16)
9 (75)
1 (8)
1 (8)
6 (67)
2 (22)
0
152 (56)
35 (13)
64 (23)
Used last 3 months73 (12)50 (8)4 (1)1 (< 1)95 (16)
Used last 30 days47 (8)35 (6)3 (< 1)1 (< 1)69 (11)
year 1stused (median)20052006200620032005
Ever used to get high26 (4)10 (2)2 (< 1)1 (< 1)30 (5)
Usual sourcea
Doctor
Friend
Street
1 (4)
10 (38)
15 (58)
2 (20)
3 (30)
5 (50)
0
1 (50)
1 (50)
0
0
1 (100)
2 (7)
12 (40)
18 (60)
Used to get high in last 3 months14 (2)7 (1)1 (< 1)015 (2)
Used to get high in last 30 days5 (1)3 (< 1)1 (< 1)08 (1)
Used to get high more than once20 (3)8 (1)1 (< 1)1 (< 1)23 (4)
Totals may not add to 100 because of missing, don’t know, and refused responses; Individuals may be represented more than once in the “Any” column if they reported on more than one drug.
a
Proportion of the usual source of drug is among those who had reported ever using/ever using to get high
Citation:
Genberg, B. et al. (2013). Prevalence and correlates of street-obtained buprenorphine use among current and former injectors in Baltimore, Maryland. Addictive Behaviors.

3 comments:

  1. I don't think that there are any misconceptions - at least among informed people that buprenorphine is used to get high. Of course buprenorphine is used to prevent withdrawal symptoms. The above survey has a big gap in the data and that is "street" sources. Buprenorphine is bought and sold on the street. There needs to be a much better survey than the current one because it misses the point. Buprenorphine can be sold at a premium in order to purchase heroin or other opioids. There is a market out there because opioid users know they can take it to cover withdrawal symptoms if they cannot acquire an opioid source. Google Suboxone x street value and you will get an estimate of this market in any number of discussion groups.

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    1. But that's an important distinction - "among informed people". Unfortunately, many policymakers, public health advocates, and even chemical dependency and mental health professionals are not well-informed of the science of opioid addiction. I can tell you anecdotally that I regularly hear folks in the treatment field say that they discourage the use of maintenance medications because they don't want their clients trading one high for another. Studies like these are important because they help increase the knowledge of the general public - granted, I agree with you that this survey has limitations. However, I think the main point I was trying to make is that if buprenorphine were more easily accessible, street sources wouldn't be needed - or, certainly, quite as common.

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