Self-Management of Buprenorphine/Naloxone Among Online Discussion Board Users

Abstract

Background: Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. Objectives: To identify facilitators of self-treatment by online buprenorphine/naloxone users. Methods: A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. Results: Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a “bad-tasting” medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely “substance-free.” The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. Conclusions/Importance: The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat.

Keywords :

• buprenorphine
• naloxone
• self-treatment
• diversion
• Internet
• discussion board

THE AUTHORS

Shan-Estelle Brown, Ph.D., is a Postdoctoral Research Associate in the Department of Internal Medicine—AIDS Program at Yale University School of Medicine. Educated at Yale University, Old Dominion University, she earned her doctorate in anthropology at the University of Connecticut. She is an applied medical anthropologist looking at the relationship between inequality and poor health outcomes. More specifically, she researches the relationship between medical technologies and people, individuals’ perceptions of risk and well-being, and structural facilitators and barriers to access to healthcare. Her current research investigates acceptability of drugs for opioid substitution therapy to understand users’ preferred method of medication delivery and what factors influence these preferences.

Frederick L. Altice, MD, is a Professor of Medicine at Yale University School of Medicine in New Haven, Connecticut. He is the Director of Clinical and Community Research of the Yale University AIDS Program for the School of Medicine, where he also directs the Community Health Care Van and the HIV in Prisons Program. Dr. Altice's research interests are focused on the interface between infectious diseases and substance abuse. As a clinical epidemiologist, health services and intervention researcher, he has created novel programs for the treatment of HIV, HCV, and tuberculosis in vulnerable populations, including injection drug users and prison inmates. Specifically, he has been an international leader in research related to adherence to antiretroviral therapy, particularly among HIV+ drug users, has made considerable in roads into novel approaches using directly administered antiretroviral therapy and other structural interventions to facilitate adherence both nationally and internationally. Dr. Altice has been at the forefront of integrating buprenorphine and methadone treatment into managing co-morbid conditions, including the management of HIV, HCV, TB, and mental illness.

Notes

1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.