Paxton Bach1, Misha Bawa2, Cameron Grant3, M J Milloy2, Kanna Hayashi4. 1. Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver BC, V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400 - 1045 Howe Street, Vancouver BC, V6Z 2A9, Canada. Electronic address: paxton.bach@bccsu.ubc.ca. 2. Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver BC, V5Z 1M9, Canada; British Columbia Centre on Substance Use, Suite 400 - 1045 Howe Street, Vancouver BC, V6Z 2A9, Canada. 3. British Columbia Centre on Substance Use, Suite 400 - 1045 Howe Street, Vancouver BC, V6Z 2A9, Canada. 4. British Columbia Centre on Substance Use, Suite 400 - 1045 Howe Street, Vancouver BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby BC, V5A 1S6, Canada.
Abstract
BACKGROUND: Buprenorphine-naloxone (BUP-NX) is a first-line treatment for opioid use disorder and has a superior safety profile compared to other forms of opioid agonist therapy. In Canada, restrictions on BUP-NX prescribing were relaxed in 2016, which may have had an effect on rates of diversion and non-prescribed use. We sought to longitudinally examine the reported availability and use of non-prescribed BUP-NX among people who use drugs (PWUD) in an urban Canadian setting. METHODS: We collected data from two linked prospective cohorts of PWUD in Vancouver, Canada, and examined self-reported availability and use of non-prescribed BUP-NX over time. We used a multivariable generalized estimating equations model to identify trends and factors associated with the immediate availability (i.e., within 10 min) of non-prescribed BUP-NX. RESULTS: Among 1617 participants between 2014 and 2020, the immediate availability of non-prescribed BUP-NX increased from 16% to 63% (p<0.001). In the multivariable analysis, factors independently associated with immediate BUP-NX availability included calendar year (adjusted odds ratio = 1.19, 95% confidence interval: 1.15-1.23), along with a number of other variables suggestive of more severe substance use disorders. Only 17 participants ever reported use of non-prescribed BUP-NX. CONCLUSIONS: We observed that BUP-NX has become increasingly available in the unregulated drug supply in recent years but its use has remained infrequent in this setting. These results suggest that relaxed restrictions on BUP-NX prescribing have not been a major driver of increased non-prescribed use in this population.
BACKGROUND: Buprenorphine-naloxone (BUP-NX) is a first-line treatment for opioid use disorder and has a superior safety profile compared to other forms of opioid agonist therapy. In Canada, restrictions on BUP-NX prescribing were relaxed in 2016, which may have had an effect on rates of diversion and non-prescribed use. We sought to longitudinally examine the reported availability and use of non-prescribed BUP-NX among people who use drugs (PWUD) in an urban Canadian setting. METHODS: We collected data from two linked prospective cohorts of PWUD in Vancouver, Canada, and examined self-reported availability and use of non-prescribed BUP-NX over time. We used a multivariable generalized estimating equations model to identify trends and factors associated with the immediate availability (i.e., within 10 min) of non-prescribed BUP-NX. RESULTS: Among 1617 participants between 2014 and 2020, the immediate availability of non-prescribed BUP-NX increased from 16% to 63% (p<0.001). In the multivariable analysis, factors independently associated with immediate BUP-NX availability included calendar year (adjusted odds ratio = 1.19, 95% confidence interval: 1.15-1.23), along with a number of other variables suggestive of more severe substance use disorders. Only 17 participants ever reported use of non-prescribed BUP-NX. CONCLUSIONS: We observed that BUP-NX has become increasingly available in the unregulated drug supply in recent years but its use has remained infrequent in this setting. These results suggest that relaxed restrictions on BUP-NX prescribing have not been a major driver of increased non-prescribed use in this population.
Authors: S A Strathdee; D M Patrick; S L Currie; P G Cornelisse; M L Rekart; J S Montaner; M T Schechter; M V O'Shaughnessy Journal: AIDS Date: 1997-07 Impact factor: 4.177
Authors: Marjolein J M Vranken; Aukje K Mantel-Teeuwisse; Saskia Jünger; Lukas Radbruch; Willem Scholten; John A Lisman; Marija Subataite; Marie-Hélène D B Schutjens Journal: Addiction Date: 2017-02-08 Impact factor: 6.526