Alternative use of buprenorphine among people who use opioids in three U.S. Cities

Priyal Gandhi, Saba Rouhani, Ju Nyeong Park, Glenna J. Urquhart, Sean T. Allen, Kenneth B. Morales, Traci C. Green, Susan G. Sherman

Research output: Contribution to journalArticlepeer-review


Background: Buprenorphine is an effective treatment for opioid use disorder, yet some persons are concerned with its “alternative use” (i.e., any use unintended by the prescriber). There is limited evidence on the factors associated with alternative use of buprenorphine (AUB); in this study, we examined correlates of recent (past 6 months) AUB. Methods: Multivariable logistic regression was used to analyze survey data from a multi-site, cross-sectional study of people who use drugs (PWUD) (N = 334) in Baltimore, Maryland; Boston, Massachusetts; and Providence, Rhode Island. Results: One-fifth (20%) of the sample reported recent AUB. In adjusted analyses, significant negative correlates of AUB were female gender (adjusted odds ratio [aOR] 0.48, 95% confidence intervals [CI] 0.24–0.95), recent emergency room visit (aOR 0.45, 95% CI 0.23–0.89), and recent injection drug use (aOR 0.41, 95% CI 0.19–0.88). Significant positive correlates were alternative use of other prescription opioids (aOR 8.32, 95% CI 4.22–16.38), three or more overdoses in the past year (aOR 3.74, 95% CI 1.53–9.17), recent buprenorphine use as prescribed (aOR 2.50, 95% CI 1.12–5.55), and recent residential rehabilitation treatment (aOR 3.71, 95% CI 1.50–9.16). Conclusions: Structural and behavioral correlates of AUB may help identify PWUD at high risk of overdose with unmet treatment needs.

Original languageEnglish (US)
Pages (from-to)364-370
Number of pages7
JournalSubstance Abuse
Issue number1
StatePublished - 2022


  • Buprenorphine
  • alternative use
  • medications for opioid use disorder
  • opioid agonist therapy

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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