Abstract
BackgroundInjectable opioids are an interesting option for people who inject drugs (PWID) that do not respond to oral Opioid Maintenance Treatment (OMT). To date, intravenous (IV) buprenorphine - a safer drug than full-opioid agonists in terms of overdose risk - has never been tested in a clinical trial on opioid dependence. We designed a survey to better understand the profile of PWID eligible for IV buprenorphine, and their willingness to receive it.MethodsThis cross-sectional community-based national survey was conducted through face-to-face interviews (in low-threshold and addiction care services) and online questionnaires (on https://psychoactif.org and other websites). Among the 557 participants, we selected those who were eligible for IV buprenorphine treatment (history of oral OMT, regular opioid injection) (n = 371). We used regression models to study factors associated with willingness to receive IV buprenorphine treatment among those with data on willingness (n = 353). In those who were willing (n = 294), we subsequently studied their willingness to receive daily supervised IV buprenorphine treatment.ResultsAmong the selected 353 participants, 59% mainly injected buprenorphine, 15% heroin, 16% morphine sulfate and 10% other opioids. Eighty-three percent of the sample reported willingness to receive IV buprenorphine treatment. Factors associated with willingness were: more than 5 injection-related complications, regular buprenorphine injection, no lifetime overdose, and completion of the questionnaire online. Factors associated with unwillingness to receive daily supervised treatment were younger age (OR[IC95%]=1.04[1.01; 1.07]) and stable housing (OR[IC95%]=0.61[0.37;1.01]) while regular heroin injectors were more willing to receive daily supervision (OR[IC95%]=2.94 [1.42; 6.10]).ConclusionsPWID were very willing to receive intravenous buprenorphine as a treatment, especially those with multiple injection-related complications. In addition, our findings show that IV buprenorphine may be less acceptable to PWID who inject morphine sulfate. Young PWID and those with stable housing were unwilling to receive IV buprenorphine if daily supervision were required. This preliminary study provides useful information for the development of a clinical trial on IV buprenorphine treatment.
Highlights
Injectable opioids are an interesting option for people who inject drugs (PWID) that do not respond to oral Opioid Maintenance Treatment (OMT)
In order to inform decisions regarding the protocol for this clinical trial, it was decided to first implement a community-based survey among frequent opioid injectors already exposed to an oral treatment, to identify their willingness to receive IV buprenorphine treatment. Study design This cross-sectional community-based survey was conducted in collaboration with the association AIDES and with the support of other associations (Psychoactif, Fédération Addiction, ASUD, Médecins du Monde) in contact with PWID. It was implemented between May and August 2015 throughout France and enrolled PWID in two different ways: a) face-to-face questionnaires proposed in different sites (low-threshold services and addiction care services) and b) online questionnaires via the community website Psychoactif.org and via an online link provided to PWID when visiting addiction care services)
42% reported that their main reason for injection was to get high, 50% to avoid withdrawal and 8% the pleasure of injecting
Summary
Injectable opioids are an interesting option for people who inject drugs (PWID) that do not respond to oral Opioid Maintenance Treatment (OMT). Despite access to Opioid Maintenance Treatment (oral methadone and buprenorphine) in France, some people who use drugs (PWUD) continue to inject opioids, mainly dissolved buprenorphine tablets [1]. While access to buprenorphine in primary care as an oral opioid maintenance treatment (OMT) has been possible since 1996 thanks to its safety profile [2, 3], methadone induction in France is possible only in specialized care [4]. In France, this is especially true for oral buprenorphine [1] Morphine sulfate, another prescription opioid (PO) used as an analgesic for persistent pain, is widely prescribed for opioid dependence and is diverted by intravenous use [8]
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