JMIR Publications

ABSTRACT

Background:

Opioid use disorder (OUD) poses medical and societal concerns. While the majority of individuals with OUD in the United States are not in drug abuse treatment, buprenorphine has been shown to be a safe and effective treatment for OUD that reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescribing increases, so does evidence of use of misused/abused/diverted buprenorphine. Users’ motivations for extra-treatment use of buprenorphine (i.e., misuse/abuse of one’s own prescription or use of diverted medication) may be different from motivations involved in analgesic opioid products. Prior research is based on small sample sizes, use surveys, and none compare motivations for buprenorphine products (i.e., tablet or film) directly with other opioid products having known abuse potential.

Objective:

To describe and compare motivation-to-use buprenorphine products and oxycodone extended-release (ER) as discussed in online forums.

Methods:

Online posts from 2012 through 2016 were collected from Web forums using the Web Informed Services (WIS) Internet Monitoring archive. A random sample of posts were coded for motivation-to-use. Posts were coded into motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (i.e., to get high), and (6) ‘other’ use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator.

Results:

Of 3,788,922 posts, 0.8% discussed motivation-to-use one of the target products. Examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (P < 0.001). Posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for opioid use disorder (OUD), tapering down use, and/or withdrawal management (P < 0.001). Buprenorphine-related posts discussed recreational use (36.8%), although much less often than in oxycodone ER posts (83.7%). Despite some differences, the overall pattern of motivation-to-use was similar for BNX sublingual film and other buprenorphine products.

Conclusions:

Analysis of spontaneous, online discussion among recreational substance users who post on Web-based drug forums support the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. While findings are consistent with a purported link between limited availability of medication assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts.