Patient Perspectives on Choosing Buprenorphine over Methadone in an Urban, Equal-access System

Overview

Journal Am J Addict

Specialty Psychiatry

Date 2013 Apr 27

PMID 23617873

Citations 39

Authors

Jan Gryczynski

Jerome H Jaffe

Robert P Schwartz

Kristi A Dusek

Nishan Gugsa

Cristin L Monroe

Kevin E OGrady

Yngvild K Olsen

Shannon Gwin Mitchell

Affiliations

Soon will be listed here.

Abstract

Background: Recent policy initiatives in Baltimore City, MD significantly reduced access disparities between methadone and buprenorphine in the publicly funded treatment sector.

Objectives: This study examines reasons for choosing buprenorphine over methadone among patients with access to both medications.

Method: This study was embedded within a larger clinical trial conducted at two outpatient substance abuse treatment programs offering buprenorphine. Qualitative and quantitative data on treatment choice were collected for new patients starting buprenorphine treatment (n = 80). The sample consisted of predominantly urban African American (94%) heroin users who had prior experience with non-prescribed street buprenorphine (85%), and opioid agonist treatment (68%). Qualitative data were transcribed and coded for themes, while quantitative data were analyzed using descriptive and bivariate statistics.

Results: Participants typically conveyed their choice of buprenorphine treatment as a decision against methadone. Buprenorphine was perceived as a helpful medication while methadone was perceived as a harmful narcotic with multiple unwanted physical effects. Positive experiences with non-prescribed "street buprenorphine" were a central factor in participants' decisions to seek buprenorphine treatment.

Conclusions: Differences in service structure between methadone and buprenorphine did not strongly influence treatment-seeking decisions in this sample. Personal experiences with medications and the street narrative surrounding them play an important role in treatment selection decisions.

Scientific Significance: This study characterizes important decision factors that underlie patients' selection of buprenorphine over methadone treatment.

Citing Articles

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Alibrahim A, Marsh J, Amaro H, Kong Y, Khachikian T, Guerrero E Subst Use. 2025; 19:29768357241312554.

PMID: 39896215 PMC: 11783500. DOI: 10.1177/29768357241312554.

Predictors of future overdose among people who inject drugs in Baltimore, Maryland.

Ramirez M, Lucas G, Page K, Zook K, Landry M, Rosecrans A Drug Alcohol Depend Rep. 2024; 13:100286.

PMID: 39430605 PMC: 11489155. DOI: 10.1016/j.dadr.2024.100286.

Shaping and shifting schemas on supervised injectable opioid treatment: findings from a cross-sectional qualitative study in two German treatment facilities.

Friedmann Z, Kinkel H, Kuhner C, Zsolnai A, Binder A, Mick I Addict Sci Clin Pract. 2024; 19(1):45.

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The effect of a pilot brief educational intervention on preferences regarding treatments for opioid use disorder.

Irani E, Macleod C, Slat S, Kehne A, Madden E, Jaffe K Drug Alcohol Depend Rep. 2024; 11():100235.

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Patient and provider medication preferences affect treatment outcomes among adolescents and young adults with opioid use disorder.

Monico L, Fletcher J, Ross T, Schwartz R, Fishman M, Gryczynski J J Subst Use Addict Treat. 2024; 162:209334.

PMID: 38531508 PMC: 11163270. DOI: 10.1016/j.josat.2024.209334.

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