Awareness of, experience with, and attitudes toward buprenorphine among opioid users visiting a New York City syringe exchange program

Authors

  • Pooja A. Shah, BS
  • Nancy L. Sohler, PhD, MPH
  • Carolina López, BA
  • Aaron D. Fox, MD
  • Chinazo O. Cunningham, MD, MS

DOI:

https://doi.org/10.5055/jom.2013.0183

Keywords:

buprenorphine, opioid agonist treatment, community-based organization, attitudes, opioids, heroin

Abstract

Objective: To examine awareness of, experience with, and attitudes toward buprenorphine, to begin to understand why opioid users may not access buprenorphine treatment. Factors associated with attitudes toward buprenorphine were also explored.

Design: Cross-sectional study.

Setting: A community-based organization’s syringe exchange program in mobile units at nine street-side outreach sites in New York City.

Participants: One hundred eighty-six adult opioid users visiting a syringe exchange program.

Main outcome measures: Awareness of, experiences with, and attitudes toward buprenorphine.

Results: Most (68.5 percent) participants were aware of buprenorphine, 27.8 percent had taken buprenorphine, and 58.6 percent knew someone who had taken buprenorphine. Of the 98 who had taken or knew someone who had taken buprenorphine, 85.7 percent endorsed positive attitudinal statements about its effectiveness, and up to 31.6 percent endorsed statements about its limited access. Participants’ attitudes about the need for formal buprenorphine treatment were mixed. Current heroin users were more likely than nonusers to have heard of buprenorphine (76.0 percent vs 61.5 percent, p < 0.05), have taken buprenorphine (46.8 percent vs 9.6 percent, p < 0.01), endorse buprenorphine’s effectiveness (96.3 percent vs 72.7 percent, p < 0.01), and believe that illicit and prescribed buprenorphine have similar benefits (35.2 percent vs 13.6 percent, p < 0.02).

Conclusions: Most opioid users visiting a syringe exchange program had positive attitudes about buprenorphine’s effectiveness, and few believed that buprenorphine was difficult to access. Attitudes about the benefits of illicit versus prescribed buprenorphine use were inconsistent. Understanding awareness of, experience with, and attitudes toward buprenorphine is important, as these factors are likely to influence opioid users’ decisions about engaging in buprenorphine treatment.

Author Biographies

Pooja A. Shah, BS

Montefiore Medical Center, Bronx, New York

Nancy L. Sohler, PhD, MPH

Sophie Davis School of Biomedical Education, City College of the City University of New York, New York, New York

Carolina López, BA

New York Harm Reduction Educators, Bronx, New York

Aaron D. Fox, MD

Montefiore Medical Center, Bronx, New York; Albert Einstein College of Medicine, New York

Chinazo O. Cunningham, MD, MS

Montefiore Medical Center, Bronx, New York; Associate Professor of Medicine, Albert Einstein College of Medicine, New York

References

Substance Abuse and Mental Health Services Administration: Results from the 2007 National Survey on Drug Use and Health: National Findings. NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD: Office of Applied Studies, 2008.

Substance Abuse and Mental Health Services Administration: National Estimates of Drug-Related Emergency Department Visits. 2006. DAWN Series D-30, DHHS Publication No. (SMA) 08-4339. Rockville, MD: Office of Applied Studies, Drug Abuse Warning Network, 200

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Treatment Episode Data Set (TEDS). Highlights - 2007. National Admissions to Substance Abuse Treatment Services, DASIS Series: S-45, DHHS Publication No. (SMA) 09-4360, Rockville, MD, 2009.

Cicero TJ, Inciardi JA, Munoz A: Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002-2004. J Pain. 2005; 6(10): 662-672.

Paulozzi LJ, Budnitz DS, Xi Y: Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. 2006; 15(9): 618-627.

Amato L, Davoli M, Ferri M, et al.: Effectiveness of interventions on opiate withdrawal treatment: An overview of systematic reviews. Drug Alcohol Depend. 2004; 73(3): 219-226.

Cooper JR: Methadone treatment and acquired immunodeficiency syndrome. JAMA. 1989; 262(12): 1664-1668.

Dole VP, Joseph H: Long-term outcome of patients treated with methadone maintenance. Ann N Y Acad Sci. 1978; 311: 181-189.

Guichard A, Lert F, Calderon C, et al.: Illicit drug use and injection practices among drug users on methadone and buprenorphine maintenance treatment in France. Addiction. 2003; 98(11): 1585-1597.

Langendam MW, van Brussel GH, Coutinho RA, et al.: The impact of harm-reduction-based methadone treatment on mortality among heroin users. Am J Public Health. 2001; 91(5): 774-780.

McLellan AT, Luborsky L, O’Brien CP, et al.: Is treatment for substance abuse effective? JAMA. 1982; 247(10): 1423-1428.

Zaric GS, Barnett PG, Brandeau ML: HIV transmission and the cost-effectiveness of methadone maintenance. Am J Public Health. 2000; 90(7): 1100-1111.

Cunningham CO, Kunins HV, Roose RJ, et al.: Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians. J Gen Intern Med. 2007; 22(9): 1325-1329.

Gunderson EW, Fiellin DA, Levin FR, et al.: Evaluation of a combined online and in person training in the use of buprenorphine. Subst Abuse. 2006; 27(3): 39-45.

Netherland J, Botsko M, Egan JE, et al.: Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2009; 36(3): 244-251.

Sullivan LE, Tetrault J, Bangalore D, et al.: Training HIV physicians to prescribe buprenorphine for opioid dependence. Subst Abuse. 2006; 27(3): 13-18.

Turner BJ, Laine C, Lin YT, et al.: Barriers and facilitators to primary care or human immunodeficiency virus clinics providing methadone or buprenorphine for the management of opioid dependence. Arch Intern Med. 2005; 165(15): 1769-1776.

Walley AY, Alperen JK, Cheng DM, et al.: Office-based management of opioid dependence with buprenorphine: Clinical practices and barriers. J Gen Intern Med. 2008; 23(9): 1393-1398.

Arfken CL, Johanson CE, di Menza S, et al.: Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians. J Subst Abuse Treat. 2010 Washington, DC, May 10, 2010.

Clark HW: The state of buprenorphine treatment. Paper presented at the Buprenorphine in the Treatment of Opioid Addiction: Reassessment 2010; February 16, 2011, 2010.

Fiellin DA: The first three years of buprenorphine in the United States: Experience to date and future directions. J Addict Med. 2007; 1(2): 62-67.

Swift JK, Callahan JL, Vollmer BM: Preferences. J Clin Psychol. 2011; 67(2): 155-165.

Olson E, Van Wye G, Kerker B, et al.: Take care east Harlem. NYC Community Health Profiles. 2006; 21(42): 1-16.

Olson E, Van Wye G, Kerker B, et al.: Take care Hunts Point and Mott Haven. NYC Community Health Profiles. 2006; 7(42): 1-16.

McLellan AT, Kushner H, Metzger D, et al.: The fifth edition of the Addiction Severity Index. J Subst Abuse Treat. 1992; 9(3): 199-213.

Turner CF, Ku L, Rogers SM, et al.: Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science. 1998; 280(5365): 867-873.

Schwartz RP, Kelly SM, O’Grady KE, et al.: Attitudes toward buprenorphine and methadone among opioid-dependent individuals. Am J Addict. 2008; 17(5): 396-401.

Egan JE, Netherland J, Gass J, et al.: Patient perspectives on buprenorphine/naloxone treatment in the context of HIV care. J Acquir Immune Defic Syndr. 2011; 56(Suppl 1): S46-S53.

Rieckmann T, Daley M, Fuller BE, et al.: Client and counselor attitudes toward the use of medications for treatment of opioid dependence. J Subst Abuse Treat. 2007; 32(2): 207-215.

The DAWN Report: Emergency Department Visits Involving Buprenorphine. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, January 29, 2013.

Cicero TJ, Surratt HL, Inciardi J: Use and misuse of buprenorphine in the management of opioid addiction. J Opioid Manag. 2007; 3(6): 302-308.

Daniulaityte R, Falck R, Carlson RG: Illicit use of buprenorphine in a community sample of young adult non-medical users of pharmaceutical opioids. Drug Alcohol Depend. 2012; 122(3): 201-207.

Johanson CE, Arfken CL, di Menza S, et al.: Diversion and abuse of buprenorphine: Findings from national surveys of treatment patients and physicians. Drug Alcohol Depend. 2012; 120(1-3): 190-195.

Gwin Mitchell S, Kelly SM, Brown BS, et al.: Uses of diverted methadone and buprenorphine by opioid-addicted individuals in Baltimore, Maryland. Am J Addict. 2009; 18(5): 346-355.

Kissin W, McLeod C, Sonnefeld J, et al.: Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis. 2006; 25(4): 91-103.

Kresina TF, Litwin A, Marion I, et al.: United States government oversight and regulation of medication assisted treatment for the treatment of opioid dependence. J Drug Policy Anal. 2009; 2(1).

Sullivan LE, Moore BA, Chawarski MC, et al.: Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. J Subst Abuse Treat. 2008; 35(1): 87-92.

Sullivan LE, Barry D, Moore BA, et al.: A trial of integrated buprenorphine/naloxone and HIV clinical care. Clin Infect Dis. 2006; 43(Suppl 4): S184-S190.

Fiellin DA, Weiss L, Botsko M, et al.: Drug treatment outcomes among HIV-infected opioid-dependent patients receiving buprenorphine/naloxone. J Acquir Immune Defic Syndr. 2011; 56(Suppl 1): S33-S38.

Altice FL, Bruce RD, Lucas GM, et al.: HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011; 56(Suppl 1): S22-S32.

Published

11/01/2013

How to Cite

Shah, BS, P. A., N. L. Sohler, PhD, MPH, C. López, BA, A. D. Fox, MD, and C. O. Cunningham, MD, MS. “Awareness Of, Experience With, and Attitudes Toward Buprenorphine Among Opioid Users Visiting a New York City Syringe Exchange Program”. Journal of Opioid Management, vol. 9, no. 6, Nov. 2013, pp. 407-13, doi:10.5055/jom.2013.0183.