Stephen Parkin

Stephen Parkin is a Research Fellow within the National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience at King’s College London. Stephen has an academic background in anthropology and public health sociology. He is a qualitative researcher with interests in harm reduction (policy and practice), homelessness (and related intervention), drug-using environments (including street-based injecting), opioid overdose (including naloxone and drug-related death), and bio-technological developments used in the treatment of disorders associated with alcohol and/or other drugs. 

Non-prescribed substance use during ‘month one’ of treatment for opioid use disorder with long-acting injectable buprenorphine: findings from a longitudinal, qualitative study

Background: Non-prescribed substance use (NPSU) alongside the prescribed use of medications to treat opioid use disorder (OUD) is widely recognised, and sometimes referred to as ‘using on top’. NPSU is associated with discontinuing treatment, especially during the early stages of treatment and before any benefit from treatment occurs. Recent treatment options for OUD include long-acting injectable buprenorphine (LAIB) (or depot-buprenorphine). This presentation explores NPSU during the first month of treatment with LAIB from the perspective of people in receipt of the medication.

Methods: Findings are based on a longitudinal qualitative study of 26 patients initiating LAIB as a treatment option. Participants were recruited from six community drug treatment centres throughout England and Wales. Semi-structured telephone interviews were held at three points in time during ‘month one’ of treatment. Data analysis focused upon transcripts from 70 of a possible 78 interviews.

Results: 17 of 26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack cocaine, non-prescribed benzodiazepines and/or cannabis. Participants’ explanations for heroin use were associated with subjective accounts of opioid withdrawal symptoms, pain management, and testing the blockade effect of buprenorphine. Heroin use was typically episodic rather than sustained. Use of crack cocaine was considered more difficult to manage (by participants) and was associated with stimulant craving and access to the substance via social connections.

Conclusions: Patients’ initial experiences and involvement with treatment for OUD are rarely addressed in qualitative research. This presentation highlights how NPSU continues to be a challenge for new medications to treat OUD.