Perceptions of Buprenorphine With Naloxone Treatment and the Fear of Precipitated Withdrawal: A Qualitative Exploration WithPrevention Trials Network 094Participants and Staff
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
ABSTRACT Introduction Uptake of evidence‐based medication for opioid use disorder (MOUD), including buprenorphine–naloxone, remains low despite the expanding US opioid crisis. This study examined participants' and staff perceptions of adopting and delivering buprenorphine–naloxone on a mobile unit providing integrated MOUD and HIV services for people with opioid use disorder who inject drugs in the HPTN 094 INTEGRA trial. dar70198-sec-0001 Methods We conducted semi‐structured interviews with people with opioid use disorder who inject drugs in the intervention or control arm (= 77) and mobile unit staff (= 38) of HPTN 094 as part of an embedded qualitative implementation science evaluation across five US cities: Houston, Los Angeles, New York City, Philadelphia and Washington, DC. Interviews were transcribed and analysed using a pragmatic inductive and deductive thematic approach. dar70198-sec-0002 Results Fear of precipitated withdrawal was a primary factor shaping perceptions of buprenorphine and other MOUD formulations. This fear was heightened by the widespread presence of fentanyl in the unregulated drug supply. Participants' MOUD preferences were influenced by their treatment goals and by misperceptions of the role of naloxone in buprenorphine and the risk of precipitated withdrawal. Additional barriers included stigma towards MOUD and infrastructure constraints that complicated buprenorphine–naloxone inductions on a mobile unit. dar70198-sec-0003 Discussion and Conclusi
Abstract
ABSTRACT Introduction Uptake of evidence‐based medication for opioid use disorder (MOUD), including buprenorphine–naloxone, remains low despite the expanding US opioid crisis. This study examined participants' and staff perceptions of adopting and delivering buprenorphine–naloxone on a mobile unit providing integrated MOUD and HIV services for people with opioid use disorder who inject drugs in the HPTN 094 INTEGRA trial. dar70198-sec-0001 Methods We conducted semi‐structured interviews with people with opioid use disorder who inject drugs in the intervention or control arm (= 77) and mobile unit staff (= 38) of HPTN 094 as part of an embedded qualitative implementation science evaluation across five US cities: Houston, Los Angeles, New York City, Philadelphia and Washington, DC. Interviews were transcribed and analysed using a pragmatic inductive and deductive thematic approach. dar70198-sec-0002 Results Fear of precipitated withdrawal was a primary factor shaping perceptions of buprenorphine and other MOUD formulations. This fear was heightened by the widespread presence of fentanyl in the unregulated drug supply. Participants' MOUD preferences were influenced by their treatment goals and by misperceptions of the role of naloxone in buprenorphine and the risk of precipitated withdrawal. Additional barriers included stigma towards MOUD and infrastructure constraints that complicated buprenorphine–naloxone inductions on a mobile unit. dar70198-sec-0003 Discussion and Conclusions Even with facilitated access, perceptions of evidence‐based MOUD were strongly shaped by fear of precipitated withdrawal. Aligning MOUD formulations with the treatment goals of people who inject drugs, along with expanding flexibility in MOUD access, delivery and induction practices across formulations, may improve uptake of these life‐saving treatments. dar70198-sec-0004 Key Points Fear of precipitated withdrawal was an important factor shaping perceptions of buprenorphine–naloxone among people who inject drugs, particularly in the context of widespread fentanyl exposure. dar70198-li-0001 Misperceptions about the role of naloxone in buprenorphine and concerns about experiencing withdrawal symptoms influenced medication preferences and willingness to initiate treatment. dar70198-li-0002 Stigma towards medication for opioid use disorder and operational challenges associated with mobile‐unit inductions created additional barriers to buprenorphine–naloxone uptake. dar70198-li-0003 Preferences for different medication formulations reflected participants' treatment goals, highlighting the importance of patient‐centred approaches to medication selection. dar70198-li-0004 Expanding flexibility in medication access, delivery models and induction practices may improve uptake of evidence‐based treatment among people who inject drugs. dar70198-li-0005 bullet dar70198-list-0001 highlights dar70198-abs-5002