Medications for Opioid Use Disorder: Patients' Experience, Knowledge, and Preferences in the Era of Illicitly Manufactured Fentanyl.

BACKGROUND

Illicitly manufactured fentanyl (IMF) presence has increased reports of buprenorphine precipitated withdrawal and may impact medication for opioid use disorder (MOUD) experiences and preferences.

METHODS

Cross-sectional survey administered by a clinical research coordinator of adults treated by an addiction consult team or bridge clinic who had prior experience with MOUD.

RESULTS

Among 100 respondents surveyed, 36% identified as female, 11% black, 9% Hispanic, 79% white, 29% had stable housing, 93% used fentanyl, and 65% injected commonly. 51% were currently treated with methadone, 41% were currently treated with sublingual buprenorphine, 12% were currently treated with extended-release buprenorphine, and 1% were currently treated with extended-release naltrexone. Most reported their current MOUD managed withdrawal and cravings well; 83.7% for methadone, 70.4% for sublingual buprenorphine, and 91.7% for extended-release buprenorphine. 75.8% of participants who tried buprenorphine reported ever experiencing precipitated withdrawal. Even so, 43.1% of those not being treated with buprenorphine were willing to start. Two-thirds reported cravings or withdrawal had worsened since IMF and 55% said IMF impacted MOUD decision making; however, 59% did not feel more worried about taking MOUD since IMF. Most (86%) had heard about low-dose buprenorphine initiation, 52.3% of those who had heard of it had tried it, and 57.8% reported positive experiences. 40% had heard of high-dose buprenorphine, 60% of those tried it, and 54.2% had positive experiences. The factors most likely to increase participants' willingness to start MOUD were immediate access (85%), rapid titration (87%), hearing positive things from friends (82%), and getting MOUD from their doctor (63%).

CONCLUSIONS

Despite IMF impacting withdrawal, cravings, and MOUD decision making, most patients felt MOUD managed symptoms well. Experiences with alternative buprenorphine initiations were positive. Access to low-barrier treatment with immediate medication initiation, aggressive dose escalation, office-based treatment, and peer-based messaging around MOUD may increase treatment uptake.