Available online at www.sciencedirect.com Drug and Alcohol Dependence 97 (2008) 105–113 Buprenorphine in primary care: Risk factors for treatment injection and implications for clinical management Perrine Roux a,b,c,* , Virgine Villes a,b,c , Jerome Blanche a,b,c , Didier Bry e , Bruno Spire a,b,c , Isabelle Feroni a,c,d , M. Patrizia Carrieri a,b,c a Inserm, U912 Economic & Social Sciences, Health Systems & Societies, Marseille, France b IRD, Aix Marseille Universit´ e, Facult´ e de M´ edecine, UMR-S912, Marseille, France c Southeastern Health Regional Observatory (ORS-PACA), Marseille, France d University of Nice Sophia-Antipolis, France e R´ eseau de sant´ e toxicomanie du Vaucluse Retox 84, France Received 21 December 2007; received in revised form 21 March 2008; accepted 22 March 2008 Available online 13 May 2008 Abstract Aims: Though the introduction of office-based buprenorphine has greatly contributed to stem the HIV epidemic since 1995, concerns have been raised about the intravenous use of buprenorphine even in patients on substitution treatment. The aim of this study was to identify which factors are predictive of buprenorphine injection in patients receiving office-based buprenorphine. Design and setting: Subazur is a survey consisting of two longitudinal assessments of 111 stabilized patients receiving office-based buprenorphine in southeastern France. Measurements: Patients were interviewed by phone at enrolment and 6 months later about social characteristics, addictive behaviors, treatment experiences, overdoses and suicide ideation or attempt. A logistic regression based on generalized estimating equations (GEE) was used to identify factors associated with buprenorphine injection at any interview. Findings: Among the 111 patients (32% women, mean age 38 years), 36 reported buprenorphine injection after having started treatment initiation in 40 interviews. After adjustment for time since first injection, individuals perceiving their prescribed dosage as inadequate (OR = 2.6 95%CI[1.2–5.7]) and those reporting a history of suicide ideation or attempt (OR = 2.7 95%CI[1.1–7.0]) had approximately a three-fold higher risk of injecting buprenorphine. Conclusions: Providing adequate care for both drug dependence and psychiatric comorbidities in primary care is a major issue. Like heroin use during methadone treatment, buprenorphine injection should be regarded more as a response to inadequate care than simply as a “misuse”. A re-assessment of the treatment efficacy through a possible dosage increase or a switch to methadone could potentially reduce diversion and assure sustained adherence to OST. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Buprenorphine; Injection; Dosage; Primary care; Opioid substitution treatment; Diversion 1. Introduction Two main opioid substitution treatments (OST) are avail- able in France for injecting drug users (IDUs): methadone and buprenorphine. The first drug to be introduced was methadone in 1995. Initiating methadone treatment is possible only in special- * Corresponding author at: Inserm U912/ORS PACA, 23 rue Stanislas Tor- rents, Marseilles 13006, France. Tel.: +33 496102876. E-mail address: p.roux@marseille.inserm.fr (P. Roux). ized centers for the treatment of drug dependence (CSST). These centers provide care to the most severe opioid dependent patients and the most socially vulnerable patients. High-dose buprenor- phine (Subutex ® ) was introduced in 1996 as a harm reduction tool to face a human immunodeficiency virus (HIV) epidemic among IDUs and has been available in primary care since then. French general practitioners (GPs) can prescribe buprenorphine without any special training or experience because of its safety profile and reduced risk of overdose. Easy access in 1996 to buprenorphine through primary care resulted in a rapid scale up of buprenorphine treatment in IDUs 0376-8716/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2008.03.025