Search

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.

Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.

Introduction: Emerging adulthood (between the ages 18-25years) has been conceptualized as a specific developmental stage based on unique psychosocial characteristics. Opioids are commonly used drugs in this population. Few studies have reported predictors of retention in buprenorphine maintenance treatment among opioid-dependent emerging adults, particularly from India. Moreover, no study has examined outcomes with opioid maintenance treatment among emerging adults in non-clinical trial, naturalistic settings. The current study aimed to assess retention in buprenorphine maintenance treatment among emerging adults in a naturalistic setting. Also, it aimed to assess the factors associated with retention in treatment among these individuals., Methods: The current study was a retrospective cohort study conducted at a substance use disorder treatment centre in northern part of India. The patients who received buprenorphine maintenance treatment between 1st January 2012 and 31st December 2014 were eligible for inclusion in the current study. The follow-up data of these subjects were assessed up to and including 31st March 2015. Information was retrieved on socio-demographic variables. The information related to substance use included type of substance, duration of use, age of onset, motive of use, route of administration and source of procurement. Additionally, details of buprenorphine dose, dispensing pattern, induction settings were recorded. Cox regression analysis was carried out to assess the predictors of retention in buprenorphine maintenance treatment., Results: Of 68 emerging adults, 33.8% were retained in treatment at 90days, 19.1% at 6months and 11.7% at one year. After controlling for various covariates in adjusted Cox regression analysis, substance use in first degree relatives (AHR: 2.40, 95% CI 1.33-4.31), lower daily buprenorphine dose (AHR: 0.86, 95% CI 0.78-0.94) and past month injection drug use (AHR: 0.30, 95% CI 0.14-0.66) were found to be the significant predictors of treatment dropout., Conclusions: The findings of the current study help understand the predictors of retention in buprenorphine maintenance treatment among emerging adults in a real-world situation. These findings will help guide formulation of responsive and relevant buprenorphine maintenance treatment program for the emerging adults., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Occupational functioning is an important parameter of substance use treatment outcome. The rehabilitation needs of the patients undergoing recovery are unique and require a tailor- made approach. This article introduces an innovative approach to addressing the occupational rehabilitation needs of patients undergoing maintenance treatment in India, a country where there are no social security provisions for the underprivileged, and where there is a lack of employment opportunities for individuals with special needs, such as drug users in recovery. This article describes the implementation of a microcredit-based, low- cost vocational rehabilitation model for 55 male patients receiving agonist (buprenorphine) maintenance treatment. The results have been encouraging, with a promise of replicability. [ABSTRACT FROM AUTHOR]