TY - JOUR
T1 - “Everything is not right anymore”
T2 - Buprenorphine experiences in an era of illicit fentanyl
AU - Silverstein, Sydney M.
AU - Daniulaityte, Raminta
AU - Martins, Silvia S.
AU - Miller, Shannon C.
AU - Carlson, Robert G.
N1 - Funding Information:
We want to thank our participants for sharing their stories with us, as well as research assistants Angela Zaragoza, Kara Schaefer, Avery Moeller, and Kylie Getz for their dedicated work on this project. The lead author would also like to thank Nick Kawa for feedback on an early draft of the paper. This work was supported by the National Institutes of Health/National Institute on Drug Abuse: R01 DA040811 (Daniulaityte, PI). The funding source had no further role in the study design, in the collection, analysis and interpretation of the data, in the writing of the report, or in the decision to submit the paper for publication. The contents do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Funding Information:
This work was supported by the National Institutes of Health / National Institute on Drug Abuse : R01 DA040811 (Daniulaityte, PI). The funding source had no further role in the study design, in the collection, analysis and interpretation of the data, in the writing of the report, or in the decision to submit the paper for publication. The contents do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/12
Y1 - 2019/12
N2 - Background: Conducted in the Dayton Metropolitan area of Southwestern Ohio, this qualitative study explores the self-treatment practices of people who use illicit opioids (PWUIO) amidst the new risk environment produced by illicit, non-pharmaceutical fentanyl (NPF). We explore local perceptions of the presence of NPF in the Dayton area, and how this has both positively and negatively impacted practices of non-prescribed buprenorphine use among PWUIO. Methods: This study analyzes qualitative data from 63 interviews conducted between October 2018 and June 2019. Participants were selected from a larger longitudinal study on non-prescribed buprenorphine use among individuals with opioid use disorder. Qualitative interviews were transcribed in their entirety, and their transcriptions were analyzed using NVivo software, drawing on a mix of thematic and inductive coding. Results: Interview respondents ranged from 19 to 70 years old, with a mean age of 38.9 years. 54% of them were male, and 85.7% identified as non-Hispanic White. 98.4% of the sample had used heroin, and 93.7% of the sample reported use of NPF. Participants agreed NPF dominated the illicit opioids market in the area, and was perceived as both dangerous and desirable. The domination of NPF and associated overdose experiences prompted some to seek positive change and initiate self-treatment with non-prescribed buprenorphine. For others, NPF sabotaged established practices of harm reduction, as unanticipated experiences of precipitated withdrawals prompted some participants to give up non-prescribed buprenorphine use as a tactic of self-treatment. Discussion: The changing nature of heroin/NPF necessarily gives rise to new beliefs surrounding self-treatment attempts, treatment seeking behaviors, and harm reduction practices. While buprenorphine treatment continues to offer promising results for treating opioid use disorders, it is urgent to reconsider how the unpredictable biochemical mixture of NPFs circulating on the streets today may impact the initiation and success of treatment.
AB - Background: Conducted in the Dayton Metropolitan area of Southwestern Ohio, this qualitative study explores the self-treatment practices of people who use illicit opioids (PWUIO) amidst the new risk environment produced by illicit, non-pharmaceutical fentanyl (NPF). We explore local perceptions of the presence of NPF in the Dayton area, and how this has both positively and negatively impacted practices of non-prescribed buprenorphine use among PWUIO. Methods: This study analyzes qualitative data from 63 interviews conducted between October 2018 and June 2019. Participants were selected from a larger longitudinal study on non-prescribed buprenorphine use among individuals with opioid use disorder. Qualitative interviews were transcribed in their entirety, and their transcriptions were analyzed using NVivo software, drawing on a mix of thematic and inductive coding. Results: Interview respondents ranged from 19 to 70 years old, with a mean age of 38.9 years. 54% of them were male, and 85.7% identified as non-Hispanic White. 98.4% of the sample had used heroin, and 93.7% of the sample reported use of NPF. Participants agreed NPF dominated the illicit opioids market in the area, and was perceived as both dangerous and desirable. The domination of NPF and associated overdose experiences prompted some to seek positive change and initiate self-treatment with non-prescribed buprenorphine. For others, NPF sabotaged established practices of harm reduction, as unanticipated experiences of precipitated withdrawals prompted some participants to give up non-prescribed buprenorphine use as a tactic of self-treatment. Discussion: The changing nature of heroin/NPF necessarily gives rise to new beliefs surrounding self-treatment attempts, treatment seeking behaviors, and harm reduction practices. While buprenorphine treatment continues to offer promising results for treating opioid use disorders, it is urgent to reconsider how the unpredictable biochemical mixture of NPFs circulating on the streets today may impact the initiation and success of treatment.
KW - Buprenorphine
KW - Fentanyl
KW - Illicit fentanyl
KW - Non-pharmaceutical fentanyl
KW - Non-prescribed buprenorphine
KW - Qualitative analysis
KW - Self-treatment
UR - http://www.scopus.com/inward/record.url?scp=85072578544&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072578544&partnerID=8YFLogxK
U2 - 10.1016/j.drugpo.2019.09.003
DO - 10.1016/j.drugpo.2019.09.003
M3 - Article
C2 - 31563098
AN - SCOPUS:85072578544
SN - 0955-3959
VL - 74
SP - 76
EP - 83
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
ER -