A Natural History Study of Buprenorphine Diversion, Self-Treatment, and Use of Drug Abuse Treatment Services

项目摘要 在美国，丁丙诺啡（BUP）的使用量大幅增加。 表明增加是由人们自我治疗阿片类药物戒断引起的。BUP转向的增长趋势 代表了一个重要的，虽然很少了解，在更大的处方药滥用问题的一部分， 美国与海洛因泛滥交织在一起这项自然历史研究的总体目的是 描述和分析海洛因和/或非医疗用途的BUP转用的性质和后果 符合DSM-5阿片类药物使用障碍标准的药物阿片类药物（NMPO）使用者。本研究将 在俄亥俄州的代顿大都会区进行，这是海洛因流行的一个新兴中心。研究 使用混合方法。在第一阶段（形成性研究），将收集定性数据， 第二阶段数据收集。第二阶段（样本招募和纵向随访）建立在一个连续的 解释性混合方法设计我们将招募400名DSM-5的社区样本 阿片类药物使用障碍，在过去90天内使用过转向的BUP。定量部分将 包括结构化基线（N=400）和两年中每六个月进行的随访访谈。的 定性部分将包括与选定个人进行的60次半结构化深入定性访谈 根据基线定量数据的潜在类别分析（LCA）结果，从较大样本中提取。的 具体目标是：1）描述BUP转移的关键方面，BUP的动机和模式， 其他药物使用、HIV/HBV/HCV风险行为、非故意过量用药史和药物滥用治疗使用。 2)确定24个月内被转用的BUP产品的使用轨迹，并分析其动态关系， 健康相关结局，包括阿片类药物使用/不使用、HIV/HBV/HCV风险行为、意外过量， 和药物滥用治疗的参与。了解BUP转用的性质及其对阿片类的影响 使用和利用药物滥用治疗服务对临床和公共卫生有重要影响。 这项研究非常重要，因为它将促进我们对关键科学研究的理解。 关于BUP转用机制和BUP转用轨迹之间关系的问题， 其他阿片类药物的戒断时间、HIV风险行为、无意过量和药物滥用治疗 寻求和参与。它具有高度创新性，因为它将是第一个提供纵向， 混合方法的方法来分析BUP转移和轨迹的使用在复杂的背景下， 自我治疗行为和使用药物滥用治疗服务之间的相互作用。混合法 设计也是新颖的，因为我们将使用LCA分析结果来选择定性样本。我们的研究 问题将提供具有关键公共卫生影响的调查结果，可用于为设计提供信息， 采取干预措施，解决非营利组织/海洛因流行病和BUP转移问题。

PROJECT SUMMARY There have been substantial increases in the use of diverted buprenorphine (BUP) in the U.S. Research suggests that increases are driven by people self-treating opioid withdrawal. A growing trend of BUP diversion represents an important, although little understood, part of the larger prescription drug abuse problem in the U.S. that is intertwined with the soaring heroin epidemic. The overall purpose of this natural history study is to describe and analyze the nature and consequences of diverted BUP use among heroin and/or non-medical pharmaceutical opioid (NMPO) users who meet criteria for DSM-5 opioid use disorder. The study will be conducted in the Dayton, Ohio, Metropolitan Area, an emerging epicenter of the heroin epidemic. The study uses a mixed-methods approach. In Phase I (formative research) qualitative data will be collected to inform Phase II data collection. Phase II (sample recruitment and longitudinal follow-up) builds on a sequential explanatory mixed-methods design. We will recruit a community-based sample of 400 people with DSM-5 opioid use disorder who have used diverted BUP in the previous 90 days. The quantitative component will include structured baseline (N=400) and follow-up interviews conducted every six months for two years. The qualitative component will include 60 semi-structured in-depth qualitative interviews with individuals selected from the larger sample based on results of Latent Class Analysis (LCA) of baseline quantitative data. The Specific Aims are to: 1) Describe key dimensions of BUP diversion, motivations and patterns of BUP and other drug use, HIV/HBV/HCV risk behaviors, history of unintentional overdose, and drug abuse treatment use. 2) Identify trajectories of diverted BUP product use over 24 months and analyze their dynamic relationship to health-related outcomes, including opioid use/non-use, HIV/HBV/HCV risk behaviors, unintentional overdose, and drug abuse treatment engagement. Understanding the nature of diverted BUP use and its effects on opioid use and utilization of substance abuse treatment services has important clinical and public health implications. The study is highly significant because it will advance our understanding of crucial scientific research questions on the mechanisms of BUP diversion and relationships between trajectories of diverted BUP use, length of abstinence from other opioids, HIV risk behaviors, unintentional overdose, and drug abuse treatment seeking and engagement. It is highly innovative because it will be the first study to provide a longitudinal, mixed-methods approach to analyze BUP diversion and trajectories of use in the context of complex interactions between self-treatment behaviors and use of drug abuse treatment services. The mixed-method design is also novel because we will use LCA analysis results to select the qualitative sample. Our research questions will provide findings with critical public health impact that could be used to inform the design of interventions to address the NMPO/heroin epidemics and issues of BUP diversion.