Evaluating the decriminalization of non-prescribed buprenorphine in Rhode Island

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ABSTRACT TEXT In July of 2021, Rhode Island became the second state in the nation to decriminalize the possession of non-prescribed buprenorphine (NPB), the partial agonist opioid medication proven effective at treating opioid use disorder (OUD), following Vermont’s decriminalization of NPB the month prior. As the nation contends with the worst fatal overdose crisis in its history, and New York State considers decriminalizing NPB for 20 million residents, there is a time-sensitive need to understand the effects of this decriminalization on people’s consumption of buprenorphine both as part of formal treatment for OUD, and as self-treatment or a form of harm reduction. To date, however, no such evaluation has been conducted. Decriminalizing NPB is a novel response to the overdose crisis, based on evidence that most NPB consumption is for the purpose of self-treatment by people who do not have access to treatment, or do not perceive themselves as ready to succeed in formal treatment programs. It has also been associated with decreases in accidental overdose, and used as a form of protection from an adulterated illicit drug supply. At the same time, concerns among policymakers and legislators persist that consuming NPB unnecessarily delays participation in more comprehensive formal treatment, that when used in combination with non-opioid depressants it can contribute to overdose, and that it contributes to addiction when consumed recreationally, especially by opioid-naïve people. The goal of this project is to explore the effects of decriminalizing NPB on attitudes and beliefs toward buprenorphine in Rhode Island, and changes in buprenorphine’s association with fatal overdoses. It offers the opportunity to systematically examine how a change in the criminal law regulating a treatment medication affects attitudes and behaviors regarding it, allowing for a rapid and broad application of the findings. Using qualitative and quantitative measures, and closely harmonizing their efforts with researchers conducting a companion evaluation in Vermont, the research team will come to an understanding of 1) the knowledge, beliefs, and behaviors regarding decriminalized NPB of people who use illicit opioids; 2) the effects of decriminalized NPB on Rhode Island law enforcement practices, attitudes and beliefs, and 3) any post-decriminalization changes in buprenorphine’s association with fatal overdoses using data from Rhode Island’s State Unintentional Drug Overdose Reporting System. The results will yield both scientific publications and products for distribution to public administration and community stakeholder audiences. The study will produce an understanding of the effects of decriminalized NPB as New York and other states consider what role NPB decriminalization should play in their public health strategies, and will reveal the most insightful research questions and metrics for measuring the health and harm reduction outcomes of decriminalization in an ensuing R01 study.