Short report
The prevalence and correlates of buprenorphine inhalation amongst opioid substitution treatment (OST) clients in Australia

https://doi.org/10.1016/j.drugpo.2010.10.004Get rights and content

Abstract

Background

Diversion and injection of buprenorphine (Subutex®) and buprenorphine-naloxone (Suboxone®) have been well documented. Recent international research and local anecdotal evidence suggest that these medications are also used by other routes of administration, including smoking and snorting.

Methods

A cross-sectional sample of 440 opioid substitution treatment (OST) clients was recruited through pharmacies and clinics in three Australian jurisdictions, and interviewed face-to-face using a structured questionnaire. Eligible participants were those aged 18 or over, who had resided in their home state for at least six months, and had been in their current treatment episode for at least 4 weeks. We compared differences in characteristics between clients who had ever inhaled (smoked or snorted) buprenorphine (including buprenorphine-naloxone) and other OST clients. Logistic regression was used to identify correlates of buprenorphine inhalation. Sixty-eight clients who had never used buprenorphine were excluded from analysis.

Results

Sixty-five clients (18%) reported having ever inhaled buprenorphine, with Subutex® smoking being most common, reported by 50 clients (77%). In multivariable logistic regression, those who reported ever inhaling buprenorphine were significantly more likely to: be aged 35 or younger, have ever been in prison and have ever injected buprenorphine. Clients from New South Wales and Victoria were significantly less likely to have ever inhaled buprenorphine than those from South Australia.

Conclusions

Our data indicates that the inhalation of buprenorphine has occurred in a significant minority of Australian OST clients. The motivations, contexts and potential health consequences of buprenorphine use by these atypical routes of administration, particularly in a correctional setting, warrant further exploration.

Introduction

Buprenorphine (Subutex®) has been available as an opioid substitution treatment (OST) in Australia since 2001, with buprenorphine-naloxone (Suboxone®) introduced in 2006 amid growing concerns regarding reports of the diversion and injection of buprenorphine both in Australia and internationally (e.g. Aalto et al., 2007, Jenkinson et al., 2005, Larance et al., 2009, Vidal-Trecan et al., 2003, Winslow et al., 2006). Recent data however shows that some injecting drug users (IDUs) also inject buprenorphine-naloxone (Degenhardt et al., 2009, Douglas Bruce et al., 2009).

Recent research has indicated that both buprenorphine and buprenorphine-naloxone are also used through routes of administration other than injecting. Intra-nasal use of buprenorphine was reported by 30% of patients receiving office-based buprenorphine treatment in France (Roux et al., 2008) and 26% of heroin injectors surveyed through a needle exchange in Sweden (Hakansson, Medvedeo, Andersson, & Berglund, 2007). Anecdotal evidence suggests that smoking of buprenorphine (typically ‘chased’ on foil) is becoming commonplace in Australian correctional facilities (Winstock, 2008). To date, however, there has been little published data exploring correlates of buprenorphine use via these routes of administration.

This paper investigated the prevalence of buprenorphine inhalation amongst a sample of patients currently receiving pharmacotherapy treatment for opioid dependence in three Australian jurisdictions, and explored key correlates of buprenorphine inhalation.

Section snippets

Data collection

This paper reports on data from a cross-sectional survey of 440 current OST clients (methadone, buprenorphine or buprenorphine-naloxone) in Victoria (VIC), New South Wales (NSW) and South Australia (SA), conducted as part of a wider post-marketing study of buprenorphine-naloxone (Degenhardt et al., 2009, Larance et al., 2009). Participants were recruited through advertisements posted in services and snowballing methods. Recruitment strategies were tailored within jurisdictions to ensure

OST client characteristics

Of the OST clients recruited into the study, 68 who had never used buprenorphine (either licitly or illicitly) were excluded from analysis. Of the 372 participants who reported ever having used buprenorphine, 85 were currently enrolled in methadone programs (23%), 149 were prescribed buprenorphine (40%) and 138 were prescribed buprenorphine-naloxone (37%). Nearly three quarters of current methadone clients reported having ever been prescribed buprenorphine or buprenorphine-naloxone (n = 60, 71%).

Prevalence and characteristics of buprenorphine inhalers

Discussion

Buprenorphine inhalation is an under-researched phenomenon that was reported by around one-fifth of this sample of Australian OST clients who had ever used buprenorphine. Despite a high prevalence of lifetime inhalation, reports of recent smoking or snorting were uncommon, suggesting that use may have been experimental. We were not able to explore the differences in subjective effects of smoking or snorting of buprenorphine compared with taking the drug sublingually, so are unable to ascertain

Conclusion

Our results show that some 20% of OST clients report experience of buprenorphine inhalation. Buprenorphine inhalation was most commonly reported in SA and by those who reported ever having been imprisoned, as well as younger clients. The association with correctional settings is worthy of future exploration, as are the potential health consequences and possible reductions in harm compared with other routes of buprenorphine administration. Work is also required to determine whether the aversive

Acknowledgments

We express our gratitude to all the opioid substitution therapy clients who participated in the study, as well as to the prescribers who allowed us to advertise through their services and who assisted with recruitment.

Thank you to A/Prof. Nick Lintzeris, Prof. Robert Ali and Prof. Richard Mattick, Chief Investigators on the wider post-marketing surveillance studies, and to the Suboxone Post-Marketing Surveillance Advisory Committee who provided feedback on questionnaire content and study

References (21)

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