Perceptions of Buprenorphine With Naloxone Treatment and the Fear of Precipitated Withdrawal: A Qualitative Exploration With HIV Prevention Trials Network 094 INTEGRA Participants and Staff.

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.

METHODS

We conducted semi-structured interviews with people with opioid use disorder who inject drugs in the intervention or control arm (n = 77) and mobile unit staff (n = 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.

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.

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.