Nonprescription use of buprenorphine tablets among patients at a tertiary care addictive disorder treatment center in India: Observations and implications

Abstract

Objective: Nonprescribed use of drugs is a clinical and public health challenge fueled by diversion of controlled opioids like buprenorphine. In this study, we report the nonprescription use of buprenorphine and buprenorphine–naloxone for the first time in India. Design: A cross-sectional observational study utilizing semistructured interviews. Setting: A tertiary care addictive disorder treatment center in India, which provides inpatient and outpatient medically oriented care that includes agonist treatment (buprenorphine) or detoxification and antagonist treatment (naltrexone). Participants: Patients aged 18-65 years, registered at the center, and who had a history of current (within the past 6 months) nonprescription use of buprenorphine tablets were recruited. Main outcome measures: Participants were questioned about demographic and clinical factors and details of nonprescription use of buprenorphine and buprenorphine–naloxone using a structured questionnaire. Since both buprenorphine with naloxone and buprenorphine without naloxone are available and transacted on the street “loose” out of the blister packs, we were unable to differentiate the use of plain buprenorphine and a combination of buprenorphine–naloxone. Results: A majority of the participants used nonprescribed tablets buprenorphine and buprenorphine–naloxone with an intent to control the withdrawal symptoms, and the reason for this use was that other patients shared their prescriptions of these medications. About half of the participants injected the tablets, and liquid pheniramine was most commonly used as the solvent for dissolving the tablets. A “high” was perceived by around half of those who injected. Participants reported knowing, on an average, around 13 peers who injected the tablet buprenorphine or buprenorphine–naloxone. Conclusion: Nonprescription use of tablets buprenorphine and buprenorphine– naloxone is a clinical concern and also an important public health issue. Geographical and systemic expansions of the availability of buprenorphine may reduce the “demand” for nonprescribed buprenorphine, while the opportunities for diversion from treatment centers can be minimized through more careful clinical prescriptions and monitoring practices.